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Initial Post on Types of Thrombocytopenia Introduction Throm…

Initial Post on Types of Thrombocytopenia Introduction Thrombocytopenia is a disease that is characterized by a low amount or abnormal functionality of platelets in the blood. A deficiency of platelets in the blood is defined as less than 150,000 platelets per microliter (National Heart Lung and Blood Institute, 2022). Due to this deficiency, the blood does not clot properly and there can be issues with excessive bleeding. The body’s platelet count can diminish due to problems with the production mechanisms, destruction of platelets in the bloodstream or by organs such as the spleen and liver. There are several different types of thrombocytopenia, each with different etiologies and treatments. These types include Thrombotic Thrombocytopenic Purpura (TTP), Drug-Induced Thrombocytopenia (DIT), Heparin-Induced Thrombocytopenia (HIT), and Immune Thrombocytopenia (ITP). These types of thrombocytopenia are all related because they involve a deficiency of blood platelets. Etiology and Genetic Risk Thrombotic Thrombocytopenic Purpura (TTP) is caused by small blood clots that block blood flow to the major organs of the body. The specific etiology of TTP originates from a deficiency of the enzyme ADAMTS13 that regulates the production of blood clots (National Heart, Lung and Blood Institute, 2022). This deficiency can be genetically passed down, or the enzyme can be destroyed by infection from a different disease, causing an excess amount of blood clots to stop blood flow which can create problems with organ function. The spleen is typically the organ responsible for destroying the ADAMTS13 enzyme (National Heart Lung and Blood Institute, 2022). Drug-Induced Thrombocytopenia (DIT) is caused by drugs that destroy platelets or prevent their production. These drugs can be medications that are meant to help with another disease, but cause clotting issues as side effects. The most common type of DIT is Heparin-Induced Thrombocytopenia (HIT), according to Gersten, 2022. HIT is caused by intake of heparin. Heparin is a blood thinner that specializes in decreasing the formation of blood clots. “HIT is caused by platelets clumping due to an immune reaction to heparin. The clumping uses them up and lowers the count” (EBSCO Medical Review Board, 2022). Although heparin is supposed to decrease the risk of blood clots, with HIT the heparin can cause a severe increase in blood clot production (EBSCO Medical Review Board, 2022). Immune Thrombocytopenia (ITP), is a disorder where the immune system malfunctions and makes antibodies that destroy platelets instead of protecting them. Platelets are usually destroyed in organs such as the spleen and liver, as well as the bone marrow (Schub, 2018). There are two types of ITP, acute and chronic. According to Schub (2018), acute ITP often affects children, whereas chronic ITP is more common in adults. Those with autoimmune disorders or prior infections are more susceptible to ITP.  Physical Assessment/Clinical Manifestations The symptoms of each type of thrombocytopenia are similar in some respects, but they differ slightly. With Thrombotic Thrombocytopenic Purpura, severe bruising (called purpura) is common, along with minor, smaller bruises (petechiae). Fever, nausea, fatigue, headaches, high heart rate, jaundice and blood in the urine are other possible symptoms (National Heart Lung and Blood Institute, 2022). For Drug-Induced Thrombocytopenia, the symptoms include purpura and petechiae, as well as “abnormal bleeding” (Gersten 2021). With Heparin Induced Thrombocytopenia, the symptoms of DIC apply, as well as having a list of its own symptoms. These include hypertension, tachycardia, chest pain, coughing and wheezing, fever and pain or swelling in the extremities (Gersten 2021). The symptoms of Immune Thrombocytopenia include “purpura, menorrhagia, epistaxis, gingival bleeding, dependent region petechiae, and retinal hemorrhages” (Schub 2018). All the types of thrombocytopenia mentioned include some form of bruising and excessive bleeding as symptoms. Hemorrhage can be a serious complication to this disease because of the blood’s inability to clot.  Clinical Practice Standards In order to diagnose thrombocytopenia, a complete blood count (CBC) must be ordered to confirm the number of platelets in the blood, as well as blood clotting tests such as PTT and PT (Gersten, 2022). TTP can be diagnosed by ordering an ADAMTS13 assay to determine the status of the ADAMTS13 enzyme. Other tests include bilirubin, bone marrow, kidney function and urine tests (National Heart Lung and Blood Institute, 2022). Treatment for TTP includes plasma treatments such as plasmapheresis and plasma infusion, as well as surgeries such as a splenectomy. Medications, such as corticosteroids, can also be used to treat TTP. For DIT and HIT, the diagnosis just includes the blood tests previously mentioned. In addition to those blood tests, a PF4 antibody test is also an effective way to diagnose these types of thrombocytopenia. With regards to treatment, the easiest way to treat these types of thrombocytopenia is to stop taking the medication causing the blood platelets to diminish (Gersten, 2021). ITP can be diagnosed by ordering an MAIPA assay, CBC, coagulation studies, and bone marrow analysis on patients over 60 years of age (Schub 2018). Treatments for ITP include platelet transfusions, medications, or a splenectomy. These treatments are similar to the other types of thrombocytopenia because each type causes the same deficiency of platelets. To determine effective treatment, however, it is crucial that a healthcare provider choose whether to treat the cause or the effect (or both) of the disease. Conclusion Thrombocytopenia is a blood disorder that involves a deficiency of blood platelets. Due to this deficiency, blood clots are unable to form, causing excessive bleeding, bruising and other, possibly fatal, complications. The different types of thrombocytopenia are thrombotic thrombocytopenic purpura, drug-induced thrombocytopenia, heparin-induced thrombocytopenia and immune thrombocytopenia.  References EBSCO Medical Review Board. (2022, February 1). Heparin-induced Thrombocytopenia.  EBSCOhost. Retrieved March 4, 2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=7155934c-c146-41d6-b2dd-4d1877dbeb8d%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=nup&AN=2010319632&anchor=ID0E2Links to an external site.  Gersten, T. (2021, July 22). Drug-Induced Thrombocytopenia. Medline Plus. Retrieved March 4,  2023, from https://medlineplus.gov/ency/article/000556.htmLinks to an external site.  Gersten, T. (2022, January 25). Thrombocytopenia. Medline Plus. Retrieved March 4, 2023, from  https://medlineplus.gov/ency/article/000586.htmLinks to an external site.  Kuter, D. (2022). Overview of Platelet Disorders. Merck Manual. Retrieved March 4, 2023, from  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders?query=thrombocytopeniaLinks to an external site.  National Heart Lung and Blood Institute. (2022, March 24). Platelet Disorders. Retrieved March 4,  2023, from https://www.nhlbi.nih.gov/health/thrombocytopeniaLinks to an external site.  Schub, T. (2018, February 23). Immune Thrombocytopenia. EBSCOhost. Retrieved March 4,  2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=9e64197f-b348-426e-81ba-38eeb62ec2cd%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T702280&db=nupLinks to an external site. 

Initial Post on Disseminated Intravascular Coagulation (DIC)…

Initial Post on Disseminated Intravascular Coagulation (DIC) Introduction Disseminated intravascular coagulation, which is more commonly known as DIC, is a rare, life-threatening disorder that is characterized by both the formation of blood clots and random bleeding episodes in patients who are critically ill (Capriotti, 2020). The clotting episodes can cause blood flow to be cut off to the organs as well as multiple organ dysfunction syndrome, which is also known as MODS (Capriotti, 2020). The bleeding episodes put the patient at risk for hemorrhage, which can be fatal. The course of treatment for DIC patients is completely dependent upon what underlying disease caused the DIC.  Epidemiology and Risk Factors Disseminated intravascular coagulation always occurs secondary to either one or several comorbid conditions, and it can occur acutely or develop into a chronic condition depending on what triggered it (Adelborg et al., 2021; Smith, 2021). There are several types of conditions that can trigger DIC, and they include cancers, blood conditions, infections, obstetric conditions, trauma or major surgery, and various forms of shock (Capriotti, 2020, p. 322). Within those categories, some conditions that put people at a higher risk of developing DIC are leukemia, metastatic cancers, acute viral infections, parasitic infections, burns, heatstroke, massive trauma, and sepsis (Capriotti, 2020, p. 322; Popescu et al., 2022). Women who experience conditions like abruptio placenta, eclampsia or preeclampsia, or amniotic fluid embolism during pregnancy or childbirth are also at a high risk of developing DIC (Capriotti, 2020). Of the conditions listed, the most common trigger of DIC is sepsis, with the disorder occurring in 30 to 50 percent of sepsis patients (Capriotti, 2020). Additionally, the mortality rate in patients who experience DIC secondary to a massive trauma is double what it is for those who do not develop it (Capriotti, 2020). This condition can develop in people of any race, and there is no gender bias. It occurs in males just as much as it does in females (Capriotti, 2020).  Etiology  DIC involves several different pathways and mechanisms in the body, which is what makes the disorder so difficult to identify and treat in time. Mainly, DIC affects the body’s ability to regulate the production of thrombin, the suppression of anti-clotting mechanisms, and the abnormal dissolving of blood clots (Capriotti, 2020; Smith, 2021). In the beginning stages of DIC, the body continuously receives stimulation to clot from procoagulant factors. As more clots form, the body depletes platelets and clotting factors, which results in excessive bleeding once the clots are dissolved (Smith, 2021). The process of excessive clotting and then excessive bleeding repeats itself until systems in the body start to be affected.  Clinical Manifestations Patients who experience disseminated intravascular coagulation may present with different symptoms, which are all dependent upon the underlying cause of the DIC (Papageorgiou et al, 2018). These patients may have petechiae or purpura on their skin, which are spots that resemble a rash that show up when blood vessels are leaking (Capriotti, 2020). Patients may also present with open wounds that are oozing blood or uncontrolled bleeding that is internal in nature or in the gums (Capriotti, 2020). Other signs and symptoms include cyanosis in the distal extremities due to lack of blood flow, limb ischemia, and gangrene (Capriotti, 2020). Shock is also common in those with DIC, and it can cause multiple organ failure or death if it is not treated in a timely manner. If the bleeding reaches the brain, it can cause severe neurological deficits, confusion, coma, or death (Capriotti, 2020). These patients will also have a depleted platelet count.  Diagnosis and Treatment Diagnosing and treating DIC can be very difficult due to the variety of causative conditions that all come with their own sets of symptoms. When a patient is being tested to confirm a DIC diagnosis, the blood will be evaluated for abnormal values of platelets, fibrinogen, activity time for antithrombin, and more (Adelborg et al., 2021). Additionally, the D-dimer test is “the most sensitive test for DIC” and an elevation demonstrates fibrinolysis (Capriotti, 2020). After a diagnosis is confirmed, treatment must start. The main goals in treating DIC are controlling the underlying causative disease, replacing clotting factors with blood transfusions, and preventing too much clotting (Capriotti, 2020). If the causative disease or condition is acute and reversible, DIC can also be reversed with the correct treatment. If the causative disease is chronic or incurable, DIC is most likely a fatal condition. In instances of significant clotting, heparin, which is an anticoagulant medication, can be given to interrupt the body’s clotting process (Capriotti, 2020). Although it can be difficult, recognizing certain symptoms, running diagnostic tests, and quickly intervening on behalf of a patient with DIC is crucial in increasing their chances of survival.  Conclusion In conclusion, disseminated intravascular coagulation, or DIC, is a rare, life-threatening condition that affects the body’s coagulation abilities. “It occurs in one percent of all hospitalized patients”, and it always occurs secondary to a causative disease or condition (Capriotti, 2020, p. 306). These patients present with many different symptoms, but the main symptoms to look out for involve uncontrollable bleeding or bleeding for no apparent reason. It is very important for patients with DIC to receive medical attention immediately in order to reverse the effects of the causative disease, if possible, and improve their chances of survival.   References Adelborg, K., Larsen, J. B., & Hvas, A. M. (2021). Disseminated intravascular coagulation: Epidemiology, biomarkers, and management. British Journal of Haematology, 192(5), 803-818. https://doi.org/10.1111/bjh.17172Links to an external site. Capriotti, T. (2020). Davis advantage for pathophysiology: Introductory concepts and clinical perspectives (2nd ed.). F.A. Davis. Papageorgiou, C., Jourdi, G., Adjambri, E., Walborn, A., Patel, P., Fareed, J., Elalamy, I., Hoppensteadt, D., & Gerotziafas, G. T. (2018). Disseminated intravascular coagulation: An update on pathogenesis, diagnosis, and therapeutic strategies. Clinical and Applied Thrombosis/Hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 24(9_suppl), 8S–28S. https://doi.org/10.1177/1076029618806424Links to an external site. Popescu, N. I., Lupu, C., & Lupu, F. (2022). Disseminated intravascular coagulation and its immune mechanisms. Blood, The Journal of the American Society of Hematology, 139(13), 1973-1986. https://doi.org/10.1182/blood.2020007208Links to an external site. Smith, L. (2021, April). Disseminated intravascular coagulation. Seminars in Oncology Nursing (Vol. 37, No. 2, p. 151135). WB Saunders. https://doi.org/10.1016/j.soncn.2021.151135

Initial Post on Hypothyroidism v Hyperthyroidism Hypothyroid…

Initial Post on Hypothyroidism v Hyperthyroidism Hypothyroidism and Hyperthyroidism are two opposite diseases. In Hypothyroidism, the thyroid produces less than an adequate amount of thyroid hormone, mainly thyroxine (T4) and triiodothyronine (T3) (Zamwar & Muneshwar, 2023). In Hyperthyroidism, the thyroid produces too much thyroid hormone. The thyroid and its hormones affect the “metabolic rate of cells throughout the body.” (Sievert, 2024). This means that the underproduction or overproduction of thyroid hormone affects health, weight, body temperature, sleep, and energy levels. However, the signs and symptoms often can go unnoticed and result in the diseases being harder to diagnose. Etiology of Hypothyroidism One of the most common causes for hypothyroidism is Hashimoto’s Thyroiditis, a condition in which the immune system attacks the thyroid cells (Sievert, 2024). The chronic destruction and inflammation of the thyroid results in a buildup of connective tissue, leading to fibrosis, which in turn causes a deficit in thyroid hormone production. Genetic and hereditary influences are the leading cause in people whose family has a history of hypothyroidism. Additionally, studies have shown that hypothyroidism is associated with genes that regulate autoimmunity, which coincides with Hashimoto’s thyroiditis being the leading cause. (Zamwar & Muneshwar, 2023). As such, genetics largely influence an individual’s risk for developing and suffering from hypothyroidism. However, other factors influence the possibility of developing hypothyroidism. These include iodine deficiency or iodine overabundance, medications, and thyroid surgery. Some medications that are used to treat hyperthyroidism can overcorrect and reduce thyroid hormone production too much. Others, especially iodine heavy drugs, can cause an immediate cessation of thyroxine production (Zamwar & Muneshwar, 2023). Lastly, the regulation of thyroid hormone production is regulated and heavily controlled by the hypothalamus and the pituitary gland through the release of thyroid-stimulating hormone, or TSH (Sievert, 2024), so any disease that can affect the pituitary gland and hypothalamus can in turn affect the thyroid, leading to either hyperthyroidism or hypothyroidism. Etiology of Hyperthyroidism Not unsurprisingly, hyperthyroidism is also heavily related to genetics. The most common cause for hyperthyroidism is Graves’ disease, an autoimmune condition which can cause excessive incitement of the thyroid, leading to an overproduction of thyroid hormone (Sievert, 2024). The mechanism of Graves’ disease is an uncontrolled stimulation of TSH receptors by TSH receptor antibodies, rather than TSH itself. Graves’ disease affects women by a large margin more than it affects men, with a ratio of eight women to one man (Bereda et al., 2022). Similarly to hypothyroidism, a genetic predisposition with a family history of autoimmune disorders or hyperthyroidism is associated with a greater risk of developing hyperthyroidism. One other major cause of hyperthyroidism is the presence of nodules on the thyroid gland, which work autonomously and overproduce thyroid hormone (Bereda et al., 2022). Clinical Presentations of Hypothyroidism and Hyperthyroidism Both hypothyroidism and hyperthyroidism can have no signs or symptoms for a long time. The signs and symptoms can easily be nonexistent, which not only causes the diseases to be harder to diagnose and treat, but can lead to life-threatening situations in which the problem is only evident after it has become severe. Other times, the signs and symptoms are evident from the outset However, even in these situations, they are usually unspecific to hypothyroidism and hyperthyroidism. Both diseases have similar issues, but often present in opposite ways. Hypothyroidism is often accompanied with weakness and fatigue, cold sensitivity, weight gain, dry skin/hair, constipation, and depression (Zamwar & Muneshwar, 2023), (Sievert, 2024). In women, it can cause irregular menstruation. Worsened moods, vision, sight, and hearing are also present occasionally. However, none of these symptoms are specific to hypothyroidism. Because the thyroid affects nearly all major organs, complications arise. An increase in blood cholesterol and blood pressure are accompanied by decreased cardiac output and heart rate. Memory loss, dementia, and cognitive decline may develop (Zamwar & Muneshwar, 2023). As such, it is critical that hypothyroidism is treated as soon as possible. In hyperthyroidism, the symptoms are often contrasting. Weight loss, an increased appetite, nervousness, anxiety, irritability, heat sensitivity and sweating, fatigue, greater frequency of bowel movements, and sleep issues are all possible symptoms of hyperthyroidism (Sievert, 2024). Some of the signs are the same, like fatigue and mood issues, but most of them are opposites. However, once again, these issues are not specific to hyperthyroidism and additional tests are required to accurately diagnose the disease. Like hypothyroidism, further complications that affect the cardiac, nervous, and circulatory system are possible. Diagnosis and Treatment of Hypothyroidism and Hyperthyroidism The most accurate way to diagnose hypothyroidism or hyperthyroidism is to run a blood test (Sievert, 2024).The test specifically detects the levels of thyroid-stimulating hormone (TSH), thyroxine (T4), or triiodothyronine (T3). In hypothyroidism, TSH levels are higher than average for the age and gender, while T4 levels are lower (Zamwar & Muneshwar, 2023). In contrast, hyperthyroidism is often classified by high levels of T4 and T3, whereas TSH levels are lower than usual (Sievert, 2024). The appropriate amount of TSH, T4, and T3 change based on the time of day, age, gender, and season, meaning that even blood tests are not always entirely conclusive (Zamwar & Muneshwar, 2023). Sometimes, there are additional tests run to detect the underlying causes of hypothyroidism or hyperthyroidism, like a radioactive iodine uptake test, or an RAIU (Bereda et al., 2022). Treatment for hypothyroidism is usually rather simple. Medications for hypothyroidism often involve just a pill or tablet that aims to increase the levels of thyroid hormone. Most times, the underlying cause is not addressed and the treatment is designed only to alleviate symptoms and complications, not restore the thyroid to proper functioning (Sievert, 2024). Hyperthyroidism is somewhat more complicated, as an increase in thyroid hormone production must be targeted rather than supplementing a lack. Some medications aim at reducing the hormone production itself, while others try to reduce the amount of thyroid gland present, destroying tissue. In some more severe cases, surgery is even possible, removing part or all of the thyroid. Each case is unique and should be dealt with as such. Follow up care for hyperthyroidism is often necessary as well (Sievert, 2024). Conclusion Hypothyroidism and Hyperthyroidism are common diseases that can affect any age group. Classified as either an abundance or deficit of thyroid hormone production, the diseases can have major complications and present in a wide variety of symptoms, sometimes not presenting at all. Genetic and hereditary risk are the greatest influences, with other actors playing into possible development of either disease. The complications can be severe and as such, treatment needs to be sought as soon as possible. However, hypothyroidism and hyperthyroidism are diseases that, when treated, are quite livable and individuals often maintain a high quality of life.  References ‌Bereda, G., et al., Science and Innovation(SNI) publications, & Bereda, G. (2022). Hyperthyroidism: Definition, causes, pathophysiology and management. Journal of Biomedical and Biological Sciences, 1–2, 1–11. Sievert, D. (2024, February 10). Hypothyroidism vs Hyperthyroidism – What’s The Difference? UCLA Medical School. https://medschool.ucla.edu/news-article/hypothyroidism-vs-hyperthyroidism-whats-the-difference#Hypothyroidism-Definition Zamwar, U. M., & Muneshwar, K. N. (2023). Epidemiology, Types, Causes, Clinical Presentation, Diagnosis, and Treatment of Hypothyroidism. Cureus, 15(9), 1–9. https://doi.org/10.7759/cureus.46241

An adolescent client has a history of abuse and neglect and…

An adolescent client has a history of abuse and neglect and is being treated for aggression and depression. Within 6 months of beginning pharmacotherapy, the family reports decreased outbursts and a more stable mood by the client. Which concept explains the behavior change in the client?