Anemia and Cardiomyopathy: Case Study Health Assessments

Diagnosing Mrs. A: Anemia and Contributing Factors

Mrs. A, who reports suffering from both menorrhagia and dysmenorrhea, is presenting classic symptoms and signs of anemia due to blood loss. Blood loss occurring over a prolonged period is a classic indicator of anemia, and she is also experiencing fatigue and lightheadedness while golfing. Considering all of these signs, it is likely that Mrs. A can be diagnosed with anemia — particularly given that she has consistently taken aspirin over the past twelve years, which can result in ulcers and gastritis (WebMD, 2014) and lead to chronic bleeding, another hallmark of anemia.

An early study (Hotz-Behofsits et al., 2003) concluded that non-steroidal anti-inflammatory drugs (NSAIDs) "cause intestinal ulcers" (p. 367), which can also be a contributing factor leading to anemia. The case study provides results of Mrs. A's blood tests showing that her red blood cell count (RBC) was abnormal, as was her hemoglobin. Ford (2013) determined that RBC morphology is a factor that medical personnel should consider when recommending appropriate and effective follow-up treatments after diagnosis.

Additional factors to consider when providing a diagnosis include the fact that anemia is often presented or exacerbated by extended exercise (such as golfing), the thin atmospheric pressure found in mountain terrain, and the long-term ingestion of aspirin or NSAIDs. It would seem, therefore, that Mrs. A is subject to a number of converging factors all pointing to the onset of anemia. The challenge, of course, is implementing a treatment program that assists Mrs. A in addressing her healthcare issue in an effective and efficient manner.

Establishing and recommending a specific treatment regimen is usually best undertaken by first determining what other symptoms or conditions the patient is experiencing. In this case, tests to determine the presence of existing conditions such as ulcers, gastritis, cancer, or hemorrhoids — all problems extending from or related to anemia — should be undertaken. Implementing effective treatment usually means addressing the problem promptly.

Mrs. A shows no signs of a large acute blood loss; rather, she has been losing blood over an extended period of time. Determining whether she requires additional blood at this time should be a good first step, and if needed, a blood transfusion would address this problem. If Mrs. A is not severely blood-depleted, then fluids, oxygen, or iron may still be deficient and in need of replacement due to anemia. Kansagara et al. (2013) determined that iron delivered intravenously was beneficial in alleviating anemia symptoms in patients. Other forms of iron replacement could be equally helpful in this particular case.

Recommended Treatment for Mrs. A

The recommended treatment should be to replace iron as quickly as possible, either through a transfusion or iron supplements. This is especially important in Mrs. A's case given that her blood results indicate she is experiencing menorrhagia and dysmenorrhea, both of which are exacerbating conditions that can lead to anemia. Additionally, Mrs. A exhibits chronic blood loss, which must also be addressed. A thorough medical discussion with Mrs. A outlining her treatment options and addressing her care in a comprehensive manner would be most beneficial at this point, as would scheduling follow-up appointments.

Mr. P appears to be suffering from a number of medical issues, both physical and mental in scope. His medical issues are also weighing heavily on Mrs. P, so effective treatment would likely be beneficial for both parties. Individuals — and their loved ones — facing such serious health conditions often become depressed, as is evidenced in this case by both Mr. P verbalizing his despondency and Mrs. P expressing her sadness and diminished mobility.

In this case, however, there is still reason for hope for both individuals in addressing Mr. P's healthcare issues, and they may still be able to share a meaningful life together. The New England Journal of Medicine reported in 2000 that the history of idiopathic dilated cardiomyopathy showed a one-year mortality rate of 10–20% and a five-year rate of 25%, representing relatively favorable rates of survival. The case study does not provide the diagnosis date, so assumptions must be made without further information; for the purpose of this analysis, it will be assumed that Mr. P has a number of years remaining if he approaches his treatment positively, with the support of his wife.

Since Mr. P appears to be currently under a doctor's care regarding his cardiomyopathy and congestive heart failure, the recommended treatment in this specific case focuses on educating and providing counseling for both Mr. and Mrs. P regarding depression and anxiety, and on helping them face the challenges that have left them both feeling the burden of long-term illness. A study determined that "depression in primary care settings continues to be under-recognized, and when diagnosed, is often inadequately treated" (Stimmel, 2001); the same study also found that patients frequently had not received adequate education about depression, its associated symptoms, or the expectations regarding treatment.