PATIENT 3 (Please answer all questions) Melissa G., a 20-year-old woman who had been diagnosed with...

PATIENT 3 (Please answer all questions)

Melissa G., a 20-year-old woman who had been diagnosed with von Willebrand's disease, was scheduled for elective surgery. Her physician wanted to stabilize her von Willebrand's factor (vWF) before surgery and ordered a therapeutic trial of l-deamino-8-D-arginine vasopressin (DDAVP) (Stimate [desmopressin]), a non-blood treatment that increases the release of vWF from storage sites (endothelial lining of blood vessels). She was a weak responder, and her vWF levels did not increase adequately; therefore, the next option was to use blood component therapy. Melissa had approximately 20% of the normal concentration of vWF.

11. What would you expect Melissa's results to be on the following coagulation tests (increased, normal, or decreased)?

a. Prothrombin time (PT)
b. Activated partial thromboplastin time (APTT) c. Platelet count
d. Bleeding time
e. VIII:C
f. Ristocetin-induced platelet aggregation (RIPA)

12. Why did the physician try nonblood treatment before ordering blood component replacement therapy?

13. What is/are the component(s) of choice for stabilizing the concentration of vWF?

Expert Solution

VWD is of three type type1(~85%) ,type 2(15%) and type 3(rare).

11.) A.) Prothrombin time: increased because in vwd patient the Prothrombin (factor 2 is decreased) resulting in increase in Prothrombin time.

B.) Activated partial thromboplastin time(APTT) : Increased because (it measures the cloting ability of factor 8,9,11 and 12) in Melissa the levels does not change after dDAVP.

C.) Platelet count: Normal because the VWD is inherited and it causes platelet dysfunction but does not affect value.

D.) Bleeding time: increased as the time taken to clot is increased the bleeding time will be more.

E.) VIII:C : decreased she had 20% of normal conc that is ~20 IU/dl which is very low seen in(type 2M /N and type 3).

F.) RIPA: Decreased or absent.

12.) dDAVP is acts via V2 receptor mediated platelet aggravation. Were it is used for checking the bleeding in vwd by releasing the factor 8 and vwf. Its partial effective in type2M and N, were completely ineffective in type 3. So to determine which type the physician must have given non blood component before administering blood components.

13.) Cryoprecipitate is one of choice for VWD, it contains 100units if antihemophilic factor and 250mg of fibrinogen were it is indicated in case of factor 8, vwf deficiency.(beacuse non responsive to dDAVP) 1unit of cryoprecipitate per 10kg bodyweight raises the fibrinogen of 50mg/dl in absence of bleeding.

Thankyou..

gladiator answered 2 years ago

Ms. G is a 62 year old woman who has been a patient for many years...

Ms. G is a 62 year old woman who has been a patient for many years at the Primary Health Center. For the past 6 months, she has complained of increasingly severe upper abdominal pain and weight loss. An ultrasound revealed a mass highly suspicious for primary liver cancer. She receives Perocet 2 tabs every 4 hours and fentanyl patch every 3 days. 1. What type of pain is Ms. G. experiencing? 2. What should the home health nurse do...

3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry,...

3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry, has been very supportive and accepting of the mental illness diagnosis. Her two children, ages 15 and 17 are worried that they might also develop bipolar disorder but are also very supportive of their mother. The family feels that they do not have the knowledge and skills to handle the condition and decide to enroll in family consultation. a. Why do you believe it...

Melissa is a 6-year-old girl who has been newly diagnosed with type 1 diabetes. Her physician...

Melissa is a 6-year-old girl who has been newly diagnosed with type 1 diabetes. Her physician has ordered a treatment regimen that includes blood glucose monitoring and regular insulin injections four times a day. Melissa and her parents have presented to the medical clinic for follow-up and teaching regarding Melissa’s condition and care needs. 1. Discuss the impact of Melissa’s diet on her diabetes management. What additional areas should be included in teaching Melissa’s parents about managing her diabetes? 2.Melissa’s...

Brief Patient History Mrs. G is a 54-year-old African American woman who has been having intermittent...

Brief Patient History Mrs. G is a 54-year-old African American woman who has been having intermittent indigestion for the past month. She has a history of hypertension and hyperlipidemia. She was admitted as an inpatient on a medical floor for management of her blood pressure and is scheduled to undergo endoscopy tomorrow. Mrs. G suddenly becomes diaphoretic and complains of nausea and epigastric pain. Clinical Assessment The rapid response team is called to evaluate Mrs. G. When the team arrives...

Barbara is a 72-year-old woman with a "Type A" personality who was diagnosed with a peptic...

Barbara is a 72-year-old woman with a "Type A" personality who was diagnosed with a peptic ulcer more than 40 years ago. At that time, her doctor told her to follow a bland diet and eat three meals per day with three snacks per day of whole milk to "quiet" her stomach. She meticulously complied with the diet to the point of becoming obsessive about eating anything that may not be "allowed." She lost 15 pounds by following the bland...

A 52 year-old woman has been diagnosed with leukemia and has been receiving chemotherapy as an...

A 52 year-old woman has been diagnosed with leukemia and has been receiving chemotherapy as an outpatient. She tells the RN that she hasn’t been feeling well. The patient’s skin is warm to touch and she has a low-grade fever of 100.2 F. The neutrophil blood count is less than 1000/ul. The nurse is concerned about the possibility of infection, why? What is the diagnosis? How would you treat this patient?

You have a 20 year old female who has been diagnosed with hypercholesterolemia and hypertriglyceridemia. Based...

You have a 20 year old female who has been diagnosed with hypercholesterolemia and hypertriglyceridemia. Based on a current evidence-based guidelines discuss what type treatment you would prescribe. Include any education you might provide. What kind of monitoring will be needed for this patient? Based on the drug class you select to treat the condition(s), discuss briefly the advantages and disadvantages of this class over other classes.

Nicole had a 5-year-old son, Karson, who had been diagnosed by his pediatric psychiatrist with ADHD....

Nicole had a 5-year-old son, Karson, who had been diagnosed by his pediatric psychiatrist with ADHD. The physician tried multiple different medications and dosages with varying results to help Karson. Some would help for a while but then stop working; some would not help at all. Frustrated after a year of medication trials, Nicole came across an advertisement for a new center called Brain Training that promised to help children with ADHD without the use of medications. It was advertised...

M. G. is a 62-year-old man with diabetes, diagnosed 3 years ago, who presents to the...

M. G. is a 62-year-old man with diabetes, diagnosed 3 years ago, who presents to the outpatient diabetes clinic for a routine preventive checkup. Subjective Data Complains of occasional dizziness when rising in the morning Follows 1,600-calorie diabetic diet Married with two grown children Retired construction worker Goes to the gym 3 times a week Objective Data Vital signs: T 37 P 118 R 18 BP 120/68 Glucose reading: 96 Weight: 165 HT: 5 feet. 8 inches 5. What interventions...

The next patient to arrive is an 85 year old woman who was brought to the...

The next patient to arrive is an 85 year old woman who was brought to the ED following three days of nausea, vomiting and diarrhea. 1. What electrolyte imbalances might the nurse expect to be present? What fluid imbalance is most likely present? 2. What are the nurse’s priority assessments to determine the presence of a fluid imbalance? 3. Given the patient’s symptoms, age, and the fluid imbalance that is likely present, what safety factors must the nurse consider when...

Question