A 65-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The complete blood count (CBC) results indicate that hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patientâs vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition.
Case Questions
1.Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
2.Should the practitioner consider a blood transfusion for this patient? Explain your answer.
3.Which medication(s) should be considered for this patient?
4.What considerations should the practitioner include in the care of the patient if an erythropoietic agent is used for treatment?
5.What follow-up should the practitioner recommend for the patient?
Case Study 2
A 60-year-old woman presents with fatigue, anorexia, weight loss, and a low-grade fever with duration of approximately 3 weeks. Her spouse is with her, and they are concerned about the symptoms she is experiencing. In addition, the woman reports that she has pain in her hands and stiffness that is worse in the morning. In her health history, the patient notes that her mother and sister both have rheumatoid arthritis (RA). The practitioner initially suspects RA as the diagnosis.
Case Questions
1.What are the three Healthy People 2020 objectives related to RA?
2.Using terms the nonâhealth-care professional could understand, describe the pathophysiology of RA.
3.What diagnostic tests should the practitioner perform for this patient?
4.What are the differential diagnoses for this patient?
Sample Solution
Bringing the least wages up in America has dependably been a disputable theme. The Federal Government sets up the base time-based compensations that a laborer can be paid and all things considered, these benchmarks of pay sway the whole country. These norms of pay or least wages were composed into law to control the unjustifiable practices of sweatshops and other free enterprise, fabricating firms. In any case, the lowest pay permitted by law laws of today guarantee that the worker being paid is given enough cash to manage the cost of necessities (Edward and Gilman, 1999). All things considered, with rising vitality costs, no genuine reasonable heath-care framework set up and rising fuel and sustenance costs the base negligibly covers the normal Americans necessities. The debate as well as issues related with standard wages come from both the positive and negative effects that it gives upon society. For instance, as least wages increment organizations are more averse to enlist new workers, to prepare or retool current representatives or to offer motivations and additionally work progressions. In switch, as wages decline firms experienced larger amounts of worker turnover rates, episodes of mishaps and regularly are left with less qualified candidates (Doyle, 2017). Seeing that quite a bit of this nations workforce is comprised of hourly representatives these lowest pay permitted by law awkward nature normally upset the principle wellspring of salary for some family units in America. Innovation and different variables of life have changed throughout the years and has enormously progressed. Be that as it may, what has stayed stale; is the increments to least wages. Accordingly, numerous individuals in America are unfit to appropriately accommodate their families. Neediness rates have expanded just as the quantity of the destitute, yet the Federal Government reports that our economy is improving. All things considered, a significant number of this incredible, Nation’s residents are unfit to give great and nourishing sustenance to themselves and their families. In light of this we are currently confronting a rising plague of weakness and disease in this nation. Due to some degree to the; sadness, heftiness, poor dietary ways of life expedited by neediness (T.H.G,2014). During the time there has been look into that has demonstrated that specialists who make more than the lowest pay permitted by law will in general be well and healthy. Notwithstanding, the Federal Government feels that by expanded least wages make uplifted dimensions of joblessness and that if least wages were expanded over ten dollars for every hour that these rates would lift radically. Believe it or not, if least wages could increment as much as $25 an hour and firms and associations would proceed to develop and succeed on the grounds that their sources of info would dependably be higher than their yields. Flourishing organizations like Amazon wouldn’t quit employing and neither would they need to raise the costs on their products to make up for expanded wages. In a perfect world, if compensation were raised it would basically develop the white collar class and low-pay laborer would be less dependence upon government help programs. Thus, dedicated Americas are standing up and dissenting for a significant increment to the base wages. This fundamentally is justified in light of the fact that in the course of the most recent couple of year’s expansion has expanded anyway pay has not. As indicated by various reports given by the Labor Board, “2007 corrections expanded the lowest pay permitted by law to $5.85 every hour which produced results on July 24, 2007; $6.55 every hour successful July 24, 2008; and $7.25 every hour powerful July 24, 2009.” Throughout quite a bit of this time America was battling 3 wars, losing a few organizations to outside bargains, managing a land emergency just as an extraordinary retreat. In this way, these moderately humble increments were not in arrangement with gas costs, swelling nor generally speaking native costs. Statics appear toward the starting 2017, twenty-nine states have a higher the lowest pay permitted by law than the standard government rate. Executing a lowest pay permitted by law increment would advance balance among the country, while likewise paying laborers a living pay which will help in one having the capacity to carry on with a tolerable and sound life. In spite of the delay from bosses, numerous American family units live off the lowest pay permitted by law, therefore legislators should build it; which will help American families with the capacity to manage the cost of the average cost for basic items. Get help with your paper today, from our expert exposition authors! Qualified journalists in the subject of social approach are prepared and holding on to assist you with your investigations. Get help with your exposition View expertly composed examples Issue The absolute minimum of anything is not exactly average and in that capacity is below average! The lowest pay permitted by law in as far as anyone knows ‘Most prominent and Strongest Nation’ on the planet falls nearer to the wages reached out to residents in less created nations. America is positioned number 9 and has a more noteworthy military and foundation than no less than two of the nations that out pay their natives. Australia which is positioned number one as it identifies with most noteworthy least wages paid to it’s laborers and natives yet this nation established in 1901 and America was established in 1776, a challenging 275 years sooner (Papworth, 2012). America’s Minimum compensation organization was built up in 1933, and upon its origin natives were paid twenty-five pennies 60 minutes. In the long run the wages were brought routinely up in the years after, with the time between increments for the most part running between a year, and up to five and six years. On Jan 1, 1981, the lowest pay permitted by law expanded to three dollars and thirty-five pennies and it stays at the dimension until 1990. The present government the lowest pay permitted by law has continued as before for a similar measure of time. It was keep going expanded on Sept. 1, 2010 at seven dollars and twenty-five pennies. (Pollin, Robert; Wicks-Lim, Jeannette,2016). As of now there are eighteen different states including the District of Columbia who have a higher the lowest pay permitted by law than what is commonly required by government law. Be that as it may, there are as yet six expresses that don’t partake in the lowest pay permitted by law. The motivation behind why this is a worldwide societal issue is on the grounds that roughly 50% of the general population winning the lowest pay permitted by law or less are more youthful laborers who are younger than twenty-five. Huge numbers of these worked still live with their folks. Measurement demonstrate that forty-one percent remain with their licenses while fifteen percent are grown-ups, who are raising a family and twenty-three percent are grown-ups who are scarcely ready to deal with themselves. In spite of the fact that, destitution has been a colossal issue for a long time (for a wide range of families), government authorities feel that raising wages would have little impact on these gathering of individuals. Analysts have demonstrated that different states crosswise over America have a lowest pay permitted by law that is higher than what is required at the administration level. In any case, the national government offers each express a chance to deal with their lowest pay permitted by law by law, however the specialist will get the higher pay of the two. “Numerous market analysts don’t care for the lowest pay permitted by law for the basic certainty it puts a stop to low-salary specialists who basically can’t deliver enough money related worth in their work to cover the lowest pay permitted by law. Regularly amid different years, for example, 2008-2012, a laborer in these circumstances needs to think about the legislature, by taking a gander at one’s neighborhood, training level, race, and age (24-65)” (Greory,2014). Another factor that could be fundamental to help increment the lowest pay permitted by law is the shoreline of living. Albeit each state has the specialist to have its own lowest pay permitted by law, a few states are less cost productive than others which require more than the standard least. “The vast majority of the worldwide work power, regardless, is the creating markets. Also, for a portion of these countries, starting a lowest pay permitted by law or raising it is unequivocally on the approach plan. However, little is considered the impacts of least wages on work and desires for expectations for everyday comforts in creating markets” (Gregory, 2014). “The average cost for basic items considers the costs of various products and ventures; though, lodging reasonableness thinks about how costly home costs are in connection to the middle family pay” (Cooper,2015). Nonetheless, everybody feels that things are costly and cost a fortune. In the wake of doing research, the states that have significant metro territories, (for example, New York and San Francisco), frequently gain fascination for vacationer and different advantages which can make it least reasonable. On the off chance that the average cost for basic items is higher than the lowest pay permitted by law, it expands the capacity to land another position or request government help. Statics additionally demonstrate that 30-half of one’s pay is spent on lease and utilities, which sometimes it is 90% of their family salary. “Albeit a few people are lease troubled, and can’t manage the cost of nuts and bolts necessities, for example, crisp products of the soil; so then again, they devour un solid sustenance that inevitable causes medical issues”. (Tsao et al 2016). Most the lowest pay permitted by law specialist because of the absence of salary can’t manage the cost of the medical advantages that they have to remain sound. In any case, their afflictions compound and frequently time an individual may begin to have sentiments of dejection or feeling down about their circumstance, this kind of attitude is additionally unfortunate for low salary Americans.>
Bringing the least wages up in America has dependably been a disputable theme. The Federal Government sets up the base time-based compensations that a laborer can be paid and all things considered, these benchmarks of pay sway the whole country. These norms of pay or least wages were composed into law to control the unjustifiable practices of sweatshops and other free enterprise, fabricating firms. In any case, the lowest pay permitted by law laws of today guarantee that the worker being paid is given enough cash to manage the cost of necessities (Edward and Gilman, 1999). All things considered, with rising vitality costs, no genuine reasonable heath-care framework set up and rising fuel and sustenance costs the base negligibly covers the normal Americans necessities. The debate as well as issues related with standard wages come from both the positive and negative effects that it gives upon society. For instance, as least wages increment organizations are more averse to enlist new workers, to prepare or retool current representatives or to offer motivations and additionally work progressions. In switch, as wages decline firms experienced larger amounts of worker turnover rates, episodes of mishaps and regularly are left with less qualified candidates (Doyle, 2017). Seeing that quite a bit of this nations workforce is comprised of hourly representatives these lowest pay permitted by law awkward nature normally upset the principle wellspring of salary for some family units in America. Innovation and different variables of life have changed throughout the years and has enormously progressed. Be that as it may, what has stayed stale; is the increments to least wages. Accordingly, numerous individuals in America are unfit to appropriately accommodate their families. Neediness rates have expanded just as the quantity of the destitute, yet the Federal Government reports that our economy is improving. All things considered, a significant number of this incredible, Nation’s residents are unfit to give great and nourishing sustenance to themselves and their families. In light of this we are currently confronting a rising plague of weakness and disease in this nation. Due to some degree to the; sadness, heftiness, poor dietary ways of life expedited by neediness (T.H.G,2014). During the time there has been look into that has demonstrated that specialists who make more than the lowest pay permitted by law will in general be well and healthy. Notwithstanding, the Federal Government feels that by expanded least wages make uplifted dimensions of joblessness and that if least wages were expanded over ten dollars for every hour that these rates would lift radically. Believe it or not, if least wages could increment as much as $25 an hour and firms and associations would proceed to develop and succeed on the grounds that their sources of info would dependably be higher than their yields. Flourishing organizations like Amazon wouldn’t quit employing and neither would they need to raise the costs on their products to make up for expanded wages. In a perfect world, if compensation were raised it would basically develop the white collar class and low-pay laborer would be less dependence upon government help programs. Thus, dedicated Americas are standing up and dissenting for a significant increment to the base wages. This fundamentally is justified in light of the fact that in the course of the most recent couple of year’s expansion has expanded anyway pay has not. As indicated by various reports given by the Labor Board, “2007 corrections expanded the lowest pay permitted by law to $5.85 every hour which produced results on July 24, 2007; $6.55 every hour successful July 24, 2008; and $7.25 every hour powerful July 24, 2009.” Throughout quite a bit of this time America was battling 3 wars, losing a few organizations to outside bargains, managing a land emergency just as an extraordinary retreat. In this way, these moderately humble increments were not in arrangement with gas costs, swelling nor generally speaking native costs. Statics appear toward the starting 2017, twenty-nine states have a higher the lowest pay permitted by law than the standard government rate. Executing a lowest pay permitted by law increment would advance balance among the country, while likewise paying laborers a living pay which will help in one having the capacity to carry on with a tolerable and sound life. In spite of the delay from bosses, numerous American family units live off the lowest pay permitted by law, therefore legislators should build it; which will help American families with the capacity to manage the cost of the average cost for basic items. Get help with your paper today, from our expert exposition authors! Qualified journalists in the subject of social approach are prepared and holding on to assist you with your investigations. Get help with your exposition View expertly composed examples Issue The absolute minimum of anything is not exactly average and in that capacity is below average! The lowest pay permitted by law in as far as anyone knows ‘Most prominent and Strongest Nation’ on the planet falls nearer to the wages reached out to residents in less created nations. America is positioned number 9 and has a more noteworthy military and foundation than no less than two of the nations that out pay their natives. Australia which is positioned number one as it identifies with most noteworthy least wages paid to it’s laborers and natives yet this nation established in 1901 and America was established in 1776, a challenging 275 years sooner (Papworth, 2012). America’s Minimum compensation organization was built up in 1933, and upon its origin natives were paid twenty-five pennies 60 minutes. In the long run the wages were brought routinely up in the years after, with the time between increments for the most part running between a year, and up to five and six years. On Jan 1, 1981, the lowest pay permitted by law expanded to three dollars and thirty-five pennies and it stays at the dimension until 1990. The present government the lowest pay permitted by law has continued as before for a similar measure of time. It was keep going expanded on Sept. 1, 2010 at seven dollars and twenty-five pennies. (Pollin, Robert; Wicks-Lim, Jeannette,2016). As of now there are eighteen different states including the District of Columbia who have a higher the lowest pay permitted by law than what is commonly required by government law. Be that as it may, there are as yet six expresses that don’t partake in the lowest pay permitted by law. The motivation behind why this is a worldwide societal issue is on the grounds that roughly 50% of the general population winning the lowest pay permitted by law or less are more youthful laborers who are younger than twenty-five. Huge numbers of these worked still live with their folks. Measurement demonstrate that forty-one percent remain with their licenses while fifteen percent are grown-ups, who are raising a family and twenty-three percent are grown-ups who are scarcely ready to deal with themselves. In spite of the fact that, destitution has been a colossal issue for a long time (for a wide range of families), government authorities feel that raising wages would have little impact on these gathering of individuals. Analysts have demonstrated that different states crosswise over America have a lowest pay permitted by law that is higher than what is required at the administration level. In any case, the national government offers each express a chance to deal with their lowest pay permitted by law by law, however the specialist will get the higher pay of the two. “Numerous market analysts don’t care for the lowest pay permitted by law for the basic certainty it puts a stop to low-salary specialists who basically can’t deliver enough money related worth in their work to cover the lowest pay permitted by law. Regularly amid different years, for example, 2008-2012, a laborer in these circumstances needs to think about the legislature, by taking a gander at one’s neighborhood, training level, race, and age (24-65)” (Greory,2014). Another factor that could be fundamental to help increment the lowest pay permitted by law is the shoreline of living. Albeit each state has the specialist to have its own lowest pay permitted by law, a few states are less cost productive than others which require more than the standard least. “The vast majority of the worldwide work power, regardless, is the creating markets. Also, for a portion of these countries, starting a lowest pay permitted by law or raising it is unequivocally on the approach plan. However, little is considered the impacts of least wages on work and desires for expectations for everyday comforts in creating markets” (Gregory, 2014). “The average cost for basic items considers the costs of various products and ventures; though, lodging reasonableness thinks about how costly home costs are in connection to the middle family pay” (Cooper,2015). Nonetheless, everybody feels that things are costly and cost a fortune. In the wake of doing research, the states that have significant metro territories, (for example, New York and San Francisco), frequently gain fascination for vacationer and different advantages which can make it least reasonable. On the off chance that the average cost for basic items is higher than the lowest pay permitted by law, it expands the capacity to land another position or request government help. Statics additionally demonstrate that 30-half of one’s pay is spent on lease and utilities, which sometimes it is 90% of their family salary. “Albeit a few people are lease troubled, and can’t manage the cost of nuts and bolts necessities, for example, crisp products of the soil; so then again, they devour un solid sustenance that inevitable causes medical issues”. (Tsao et al 2016). Most the lowest pay permitted by law specialist because of the absence of salary can’t manage the cost of the medical advantages that they have to remain sound. In any case, their afflictions compound and frequently time an individual may begin to have sentiments of dejection or feeling down about their circumstance, this kind of attitude is additionally unfortunate for low salary Americans.>