• Internal Code :
  • Subject Code : NURS90129
  • University : University of Melbourne
  • Subject Name : Nursing

Case Study: Klara, George and Sam

Case study 1

a) Klara's blood count report indicates that she is suffering from the deficiency of red blood cells and iron. Red blood cells are very important for the body as they take oxygen from the lungs and provide to all the other parts of the body. They also remove carbon dioxide from the body. The red blood cell contains an iron-pigment named haemoglobin or Hb that is the actual transported of oxygen. It has a high affinity towards oxygen molecules and binds with them. The red blood cells have mean corpuscular haemoglobin (MHC); that is the average number of Hb in the blood. The average amount of oxygen transported in the body is maintained by MHC. The average number of Hb present in the RBC is termed as corpuscular haemoglobin concentration (MCHC). The MCHC value is used to detect the average concentration of Hb in RBCs. Hematocrit or HCT in the blood report is defined as the blood volume that contains RBCs; it represents the blood volume that is capable of oxygen transportation.

WBCs (White blood cells) and platelets are also blood cells, but they are not involved in oxygen transportation. WBCs are parts of the immune system as they protect the body from pathogens or antigens while the platelets are responsible for the formation of blood clots to prevent bleeding. The iron report depicts the values of serum iron, transferrin and ferritin. The serum iron is defined as the iron present in the blood serum; it represents the abnormal iron levels in the blood serum. Transferrins are defined as the glycoprotein that can bind with iron-molecules; they are responsible for transporting iron molecules through the blood. The ratio of serum iron to the iron-molecules binds with transferrins is termed as transferrin saturation, and this ratio indicates the amount of serum iron that is bounded with transferrin. The proteins that have the capability of binding to iron are called ferritin, and their concentration indicates the amount of iron that is present in an individual's body.

Klara shows a deficiency of Iron and red blood cells, both of the factors are inter-related to each other; her body is not having enough iron, which can help in the formation of red blood cells. Low red blood cell formation and lack of iron lead to anaemia, a haematological disorder. Deficiency of iron results in the declination of red blood cell formation that enables the cells to carry oxygen and leaves the person tired and short of breath. In the given case study Klara is facing shortness of breath as she is breathing faster and deeper, lethargy, nausea, dizziness, and light-headedness and all these symptoms are the outcomes of lack of iron and low red blood cell count.

b) Klara is facing respiratory problems like fast and deep breathing and has shown low red blood cell count and iron deficiency. Red blood cells help in carrying oxygen throughout all body parts. However, iron is a critical factor in this process. An insufficient amount of iron in Klara’s body leads to oxygen depletion that results in fast and deep breathing. In Klara’s case, cellular respiration is affected as iron deficiency impairs the respiratory and cardiac function on the cellular level. It directly impairs the mitochondrial respiration and reduces contraction and relaxation. Iron plays a crucial role in storing cellular oxygen because of its oxygen uptake and transportation mechanism as a part of haemoglobin. Iron helps in metabolism, redox cycling, and works as an enzymatic cofactor. Therefore, deficiency of iron leads to dysfunction of mitochondria, and this is why maintenance of iron is essential in order to attain balanced cellular respiration.

Iron is a necessary element for oxygen transport, cellular respiration, involvement in the metabolism of numerous cellular proteins, and enzymes; its deficiency reduces cellular respiration and leads defective electron transport. Red blood cells containing haemoglobin carry oxygen, and lack of red blood cell count will impair this oxygen transfer as a result of muscle that constitutes a significant bulk of anyone’s body as well as the heart that has iron- containing protein myoglobin. This protein myoglobin present in large quantity in muscles behaves as an essential oxygen trapping proteins. There are a large number of mitochondrial proteins in cells that contain iron and so many cellular cycles and pathways require iron as a cofactor for their enzyme activity. Each time during inhalation, fresh oxygen molecules are drawn into the body. The oxygen then passes through the lungs and then make the path into the bloodstream, in the bloodstream it gets attached to the haemoglobin present in the red blood cells and then moves forward to the blood vessels for delivery.

Mitochondria produces energy in the form of ATP (adenosine triphosphate) in the presence of oxygen. It needs aerobic conditions for ATP production; in case, the body does not has enough Hb, then it is unable to bind with more oxygen molecules. Due to this, oxygen transportation gets reduced, and mitochondria do not get enough oxygen to produce sufficient ATP molecules. What exactly happened in Klara’s case, is this reduction in red blood cells that leads to insufficient delivery of oxygen which tends to create problems in breathing. This decline in iron and iron-containing enzymes in cardiac, skeletal, and liver mitochondria that results in impaired metabolism of oxygen and alters the morphology of mitochondria which does not only affect the cellular respiration but along with that makes the patient feel weak, dizzy, tired and will find difficulty in breathing.

Case study 2

a) Influenza is a viral respiratory infection caused by the Influenza virus, which leads to an illness that could be mild, severe, and fatal too. In order to confirm the suspected influenza infection, George’s doctor has collected viral swabs because it will help in detecting the presence of viruses in the respiratory secretion of George. For obtaining the accurate results of the test nasal aspirate sample is the best because it contains the maximum number of viruses if the patient is infected with influenza. However, nasal swab or swab from nasopharynx can also be used, but comparatively, they contain a lesser number of virus.

b) George is suspected to be infected by the influenza virus as he complains sore throat and dry cough. A sore throat is a reflex action that tends to clear mucus trapped in the throat. Sore throat and dry cough are common symptoms of viral and bacterial infections. Influenza is one of the viral infections that primarily affects the respiratory system. The target organs of the influenza virus include the throat and lungs. The virus enters the body through the nasal passage. After entering the nose, it enters the throat due to which the patients suffering from influenza have symptoms of sore throat and drug cough. Some of the other symptoms that are caused by influenza virus include muscle pain, weakness, fatigue and nasal congestions.

The other symptoms of influenza include chills, high fever and warm skin. The skin of the face gets warm and flushed due to the influenza virus. At first, the respiratory problems are not severe, but after a few days; the influenza virus severely affects the lungs and other respiratory parts. This is because this virus divided multiply and then impacts the respiratory disease. The influenza virus affects the patient's throat, lungs and nose. The influenza virus first affects the throat due to which the patients' of influenza have sore throat and cough. The influenza virus affects the upper respiratory tract such as nasal passage, pharynx, sinus, and larynx and then eventually head it towards the lungs.

Furthermore, such infection is caused by the invasion of the mucosa, i.e. inner lining of the trachea (upper airway) by the infectious agent and for successfully invading to the mucosa of the upper airway, the infectious agent needs to cross several immunologic and physical barriers. Somehow, when the virus crosses these barriers produce toxins and impairs or alters the cells of the defence system. Infecting these structures of the upper respiratory tract leads to lethargy, runny nose, sore throat, breathing difficulty, and cough. Infecting the structures of the upper respiratory tract leads to lethargy, runny nose, sore throat, breathing difficulty, and cough. The sore throat can be cured by taking medications at the correct time. The dry cough caused by the influenza virus can also be cured by taking accurate cough preventing medications. Early detection of influenza, proper treatment and use of medications is essential for reducing the symptoms of influenza. These steps help in treating sore throat and dry cough.

Having sore throat and cough comes up with other symptoms that George has been facing, and these symptoms are mentioned below:

  1. a scratchiness in the throat

  2. pain in the throat that gets worse during swallowing

  3. difficulty in talking and swallowing

  4. swollen glands in jaw and neck region

  5. coughing

  6. fever

  7. breathing difficulty

  8. chills

  9. sweat

c) George developed a fever in response to viral infection because it is the cardinal response towards the infection and the main purpose of a fever is to raise the temperature of the body to kill certain viruses that are sensitive to temperature. The high temperature of the body reduces the replication of the virus and exerts some antiviral effects. It does reduce not only viral replication but also decreases cell viability and dome formation. However, increment in the number of detached cells and lactate dehydrogenase level occurs, which results in reducing the viral titers. Fevers during infection are caused by pyrogens that flow in the bloodstream. These pyrogens are headed towards the hypothalamus in the brain that regulates the body temperature. When these pyrogens get bind to some specific receptors of the hypothalamus, it tends to raise the temperature of the body. One of the most common pyrogens is interleukin-1 and interleukin-6. These pyrogens are produced by white blood cells when certain viruses come in contact with them.

d) The medication, paracetamol is more appropriate for George in this situation, current evidences have suggested that for some types of pains and fever that arise during flu can be eased and reduced if a combination of paracetamol is taken with an NSAID such as ibuprofen because together they will provide better analgesia than consuming a single drug. However, George also has kidney issues, and NSAIDs such as ibuprofen are not suitable for the patients having kidney diseases. This is because NSAIDs such as ibuprofen can cause severe and chronic kidney disease. The long-term use of such drugs can worsen the conditions of the kidneys. Thus, administration of the drug paracetamol has been considered to be safe, and it can also help to ease the symptoms of viral infection.

Case study 3

a) The cranium is the part of the body that contains the brain and cerebrospinal fluid. It plays an essential role in maintaining intracranial pressure. The cerebrospinal fluids exert pressure on the tissues of the brain, and this pressure is termed as intracranial pressure. The increase in the intracranial pressure within the cranium causes an abnormal condition called intracranial hypertension or IH. The cranium maintains the intracranial pressure and any fluctuation in this pressure can be fatal as it can damage the brain. The condition in which blood gets collected in the brain due to accidents and other brain injuries is termed as an intracranial hematoma. This condition increases intracranial pressure and leads to intracranial hypertension.

Sam’s CT scan reports showed that he has a linear fracture, which involves temporal bone and an underlying haematoma. Due to the injury and linear fracture, Sam suffers from the haematoma that results in excessive fluid pressure in the brain, and this pressure increases the intracranial pressure. Cranium acts as the first line of defence that protects the brain from all types of injuries and accidents. The impaired cranium affects the integrity of the immune system, as the impaired cranium is not able to protect the brain effectively. Moreover, the cranium also protects the brain from trauma and shocks, and the people with impaired cranium are more prone to brain injuries as their cranium does not adequately protect their brain. Thus, impaired cranium is also unable to maintain the intracranial pressure that can be fatal in some cases.

b) Brain injuries often result in physical dysfunction or impairment of cognitive abilities. It also results in behavioral dysfunction. In Sam’s case, swelling goes extensive in the brain, and such a situation is known as cerebral edema. Cerebral edema is caused when excessive fluid starts to develop in the brain, and this condition can be life-threatening too because the fluid inside the brain exerts and increases the pressure inside the skull. This pressure is known as intracranial pressure. While the brain always needs the proper uninterrupted flow of oxygen to function well, an extensive increase in intracranial pressure leads to the sudden drop of oxygen in the brain. This excessive accumulation of intracranial fluid may lead to altering the brain function in a bilateral way as it will increase the distance of diffusion for oxygen and other essential nutrients and hence, compromise the cellular metabolism and will lead to the impairment that will limit the removal of toxic byproducts. Not only this but the rapid shifting of cerebrospinal fluid through the spaces of paravascular to the brain from cisterns will occur that will result in a sudden increase in water content in the brain, and this would disturb the paravascular system’s function and enhances the chances of morbidity and mortality. Other complications that may arise are memory loss, difficulty in breathing as well as speaking, unconsciousness, slowed ability in processing information, balance problems, anxiety, depression, difficulty in concentrating, and initiating activities.


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