Question

A 62-year-old elderly woman, Mrs. NM, comes into the emergency room with a Chief Complaint of generalized weakness and moderate shortness of breath, with heavy epistaxis for the past 20 hours. The patient also related that she had bitten the inside of her mouth about 1 week ago, and she still had mild, occasional bleeding from the site, despite being extremely careful with chewing food and brushing teeth. Pt. also stated that she sometimes her stools are very dark, but stated that she eats beets every night. Pt. reported a recent upper respiratory infection, which she went to see her Primary Care Physician for, who prescribed Bactrim for 7 days, which she completed two days ago. Pt. denied any changes in appetite.

Pt. history includes, Breast Cancer (2 years ago), Diabetes Miletus, Hyperlipidemia, and High Blood Pressure.

Surgery history includes Right Breast Mastectomy.

Current reported Medications: Tamoxifen,  Glyburide 2.5 mg BID, Atorvastatin 20 mg QHS, Norvasc 5 mg BID

Pt. denies smoking, drinking, and/or illicit drug use

Pt. denied use of any herbal and/or over the counter medications.

On Physical Examination, the patient was an elderly woman with no apparent distress but obviously weak. Height and weight were appropriate for age. Multiple attempts for BP on the right arm revealed 90/55. Oxygen Saturation: 95% on room air. Pt. was afebrile. Lungs were clear to auscultation. Neurological evaluation was normal. Skin was dry and turgor was reduced. There was a round, inflamed lesion of dried blood located on the right buccal mucosa. Skin revealed diffuse petechial on the bilateral upper and lower extremities, as well as across the lower abdomen.

Laboratory work-up:

Basic Metabolic Panel: Within in normal limits

White Blood Cell: 8 μL

Hgb: 7.1 g/dL

Hct: 21.2 %

Platelet count: 50,000 mm3

QUESTIONS:

1. What are the causes of this suspected disease process?

2. What dietary recommendation would you include for this patient? Give examples.

Answer 1

a Patient may be suffering from Thrombocytopnea which confirms with the low platelet level Normal Platelet count T = 150,000 to 4, 5000 Patient has only 50,000 count so. It increases the chances of bleeding As Patient show's epistaxis and mouth bleeding -Diet ay recommendation for Patient with thrombocytopenia El Gat healthy diet with lots of fruits and vegetables, especially leafy greens, to give your body the nutrients it needs - Lean meats such as fish, chicken and turkey are ich in protein, zinc. and vitamin BR., all of which help increase the blood platelet count Beans contain vatanan Bg or folate which greatly helps boost the blood Platelet count eg. spinach, oranges and asparagus = Vit C rich food - mangoes, brocooli, Pineapple, tomatoes, bell papers, cauli Howa =) papayer leaf extract

Answer 2

1. Does she had taken any over the counter drugs?

Is she having the complaint for the first time ?

Did she had this after taking tamoxifen ?

Does she have normal.CBC counts before ?

2. Blood teststo be ordered are :-

- PT

- PTT

- APTT

- INR

- CBC