peer Response

Stacey

All the critical observations are noted in your post. That is regarding the chief complaint, medications, allergies, past medical history, her diagnostics, and genitourinary. Thus, I agree with your assessment and that it should be directed towards iron-deficiency anemia secondary to abnormal uterine bleeding (AUB). AUB concerns the normal menstrual cycle variations, to “undergo variations in regularity, frequency, duration of flow, or amount of blood loss” (Whitaker & Critchley, 2015). However, as from the case study, many women who suffer from AUB do not seek medication, either because they think the diagnosis is subjective or consider their condition normal (Davis & Sparzak, 2020).

The current assessment is supported by many studies, with the recent one revealing a direct link between iron deficiency and fatigue for the female gender (Neidlein et al., 2020). Notably, Jessica’s iron deficiency has been found among the outcomes of heavy menstrual bleeding (HMB), and its symptoms include fatigue (Sriprasert et al., 2017). Therefore, you have correctly stated that assessment should be directed towards iron-deficiency anemia secondary to AUB and, the etiology of abnormal bleeding should be investigated. Precisely, HMB causes iron deficiency, and thus fatigue (O’Brien, 2018). Treatment goals from such as assessment, would entail restoring or stopping menses, managing medical conditions that aggravate HMB, and encouraging BMI management. Overall, the treatment plan should improve Jessica’s quality of life.

References

Davis, E., & Sparzak, P. (2020). Abnormal Uterine Bleeding. StatPearls Publishing.

Neidlein, S., Wirth, R., & Pourhassan, M. (2020). Iron deficiency, fatigue, and muscle strength and function in older hospitalized patients. European Journal Of Clinical Nutrition. https://doi.org/10.1038/s41430-020-00742-z

Sriprasert, I., Pakrashi, T., Kimble, T., & Archer, D. (2017). Heavy menstrual bleeding diagnosis and medical management. Contraception And Reproductive Medicine, 2(1). https://doi.org/10.1186/s40834-017-0047-4

Whitaker, L., & Critchley, H. (2015). Abnormal Uterine Bleeding. Ultrasound In Medicine & Biology, 41(4), S71. https://doi.org/10.1016/j.ultrasmedbio.2014.12.305

Response to Valencia

The correct assessment is okay, although I find some data not provided in the case study. For instance, there was no test on illicit drug use. Nevertheless, this is an excellent outline for which one can systematically assess Jessica. For instance, Jessica’s hygiene is highlighted, thus helping to out rule unhygienic conditions for heavy menstrual bleeding, causing blood clots (Hapangama & Bulmer, 2016). The absence of genital infections qualifies HMB as the cause of the clots. Also, changing her antihypertensive treatment to ACE inhibitors such as lisinopril to better control her HTN is an ideal treatment intervention.

While it is okay to say that certain foods can also make it harder for your body to absorb ferrous sulfate, I think iron deficiency is an outcome of a more serious issue than absorption inhibition. Inarguably, Ferrous sulfate will be crucial in the treatment of iron deficiency, but the main condition – AUB will persist. I think the better approach would be an assessment directed towards iron-deficiency anemia secondary to AUB and, investigation of the etiology of abnormal bleeding. Studies have found a direct link between iron deficiency and fatigue for the female gender (Neidlein et al., 2020). Another study has added that fatigue is among the symptoms of heavy menstrual bleeding (HMB), (Sriprasert et al., 2017). Connecting both studies suggests that HMB causes iron deficiency, and thus fatigue (O’Brien, 2018). Therefore, the treatment goals would entail restoring a regular menstruation cycle or stopping it, managing medical conditions that are risk factors for HMB, and reducing body weight management. Overall, the treatment plan should improve Jessica’s quality of life.

References

Hapangama, D., & Bulmer, J. (2016). Pathophysiology of Heavy Menstrual Bleeding. Women’s Health, 12(1), 3-13. https://doi.org/10.2217/whe.15.81

Neidlein, S., Wirth, R., & Pourhassan, M. (2020). Iron deficiency, fatigue and muscle strength and function in older hospitalized patients. European Journal Of Clinical Nutrition. https://doi.org/10.1038/s41430-020-00742-z

Sriprasert, I., Pakrashi, T., Kimble, T., & Archer, D. (2017). Heavy menstrual bleeding diagnosis and medical management. Contraception And Reproductive Medicine, 2(1). https://doi.org/10.1186/s40834-017-0047-4