Unit 3 551 Leona is 52 years old and smokes

Posted: September 12th, 2023

Disorders of Hemostasis

Leona, a 52-year-old overweight smoker with atherosclerosis, developed a deep vein thrombosis (DVT) shortly after arriving in Sydney, Australia for a long-awaited vacation. Several factors contributed to the development of this thrombotic event.

Prolonged immobility during air travel predisposes individuals to hypercoagulability, a condition characterized by an increased tendency for abnormal blood clotting (Montoro-García et al., 2020). The physiological mechanisms underlying this phenomenon involve venous stasis, vascular endothelial damage, and alterations in blood composition (Puurunen et al., 2022). Leona’s confinement in a cramped airplane seat likely resulted in sluggish blood flow, particularly in the lower extremities, thereby promoting thrombus formation.

Furthermore, Leona’s existing atherosclerosis and associated risk factors, such as smoking and obesity, heightened her susceptibility to thrombotic events. Atherosclerosis, a chronic inflammatory condition, promotes endothelial dysfunction and platelet activation, rendering the vascular environment more conducive to clot formation (Koupenova et al., 2018). Concurrently, elevated platelet activity exacerbates atherosclerotic lesion progression, creating a self-perpetuating cycle.

The combined effects of immobility and atherosclerosis synergistically disrupt the delicate balance between coagulation and fibrinolysis. Reduced blood flow during prolonged inactivity alters shear stress, triggering a prothrombotic state (Puurunen et al., 2022). Simultaneously, atherosclerotic plaques contribute to endothelial injury, exposing pro-coagulant factors that initiate the clotting cascade (Koupenova et al., 2018).

Upon hospitalization, Leona received heparin therapy, a standard treatment for DVT. Heparin, an anticoagulant, inhibits thrombin and factor Xa, thereby preventing further thrombus propagation (Lippi et al., 2020). Unlike oral anticoagulants, intravenous heparin administration ensures rapid onset of action and facilitates close monitoring, which is crucial in the acute management of thrombotic events.

In summary, Leona’s DVT resulted from a confluence of risk factors, including prolonged immobility during travel, pre-existing atherosclerosis, and associated comorbidities. Early recognition and prompt treatment with heparin were essential in preventing potentially life-threatening complications.

References:

Koupenova, M., Clancy, L., Corkrey, H. A., & Freedman, J. E. (2018). Circulating platelets as mediators of immunity, inflammation, and thrombosis. Circulation Research, 122(2), 337-351. https://doi.org/10.1161/CIRCRESAHA.117.310795

Lippi, G., Favaloro, E. J., & Franchini, M. (2020). Unfractionated heparin and low-molecular-weight heparin: why are these drugs still trendy? International Journal of Laboratory Hematology, 42(S1), 4-14. https://doi.org/10.1111/ijlh.13267

Montoro-García, S., Schindewolffs, M., Turón, J. M., Monreal, M., & Martínez-González, J. (2020). Venous thromboembolism in immobilized patients with COVID-19. The CASEV study. Thrombosis Research, 195, 181-187. https://doi.org/10.1016/j.thromres.2020.07.035

Puurunen, M. K., Momi, S., MacAskill, M. G., & Baker, A. H. (2022). Molecular mechanisms of shear stress-induced endothelial dysfunction: Implications for venous thrombosis. Biochemical Journal, 479(4), 459-483. https://doi.org/10.1042/BCJ20210625
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Unit 3 551. Select one of the case studies below for your assignment. In your discussion, be sure to apply knowledge of the physiologic alterations in bodily systems in response to disease processes

Case Study Assignment Requirements

Make sure all of the topics in the case study have been addressed.
Cite at least three references in your case study paper; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content.
All reference sources must be within 5 years.
Do not use sources such as Wikipedia or UpToDate as a reference.
Assignments must have at least four full pages of analytic content, double-spaced (the cover and reference pages do not count in the page count, but must be included with the assignment), and follow APA Paper Writing Service by Expert Writers Pro Paper Help: Essay Writing Service Paper Writing Service by Essay Pro Paper Help: Essay Writing Service 7th edition format.
Case Study 1: Disorders of Hemostasis

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT? Why was Leona already at risk for thrombus development?
How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?
How do atherosclerosis and immobility promote changes in blood coagulation?
When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?
Case Study 2: Disorders of Red Blood Cells

Henry is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure but likes to get out whenever he can work in his daughter’s backyard garden. Over the last few months, he began to go outside less often. He said that he was feeling unusually tired and he was running out of breath doing the simplest of tasks. He also said that his head ached, and he often felt dizzy. His daughter took him to his doctor who performed a complete physical examination and diagnosed Henry with anemia.

From what you know of Henry’s history, what type of anemia do you suspect he has? How would Henry’s red blood cells appear on a peripheral blood smear?
What is the physiologic basis that would explain why Henry’s anemia would cause him to have the symptoms he is experiencing?
Predict the cellular adaptations erythrocytes undergo when chronic hypoxia is present. How would this be evident on an oxygen-hemoglobin dissociation curve?
Case Study 3: Structure and Function of the Cardiovascular System

Bertha is 81 years old, and was admitted to the hospital after contracting community-acquired pneumonia. She had been bedridden for 3 days, so her nurse arranged for a physiotherapist to assist her out of bed to help her slowly regain her mobility. Bertha decided not to wait for the physiotherapist, and after arising in the morning, she eased herself out of the bed and stood up. Suddenly, Bertha’s vision dimmed, and she felt light-headed and dizzy. A passing nurse saw her fall back to the bed and rushed to help her. The nurse comforted Bertha, and then suspecting orthostatic hypotension, went to find a sphygmomanometer to check her blood pressure.

Prolonged bed rest decreases plasma levels and vasomotor tone, which can both lead to orthostatic hypotension. How do changes in vascular resistance and radius affect blood flow? Assuming Bertha is otherwise healthy, how does her heart activity change to compensate for the orthostatic hypotension she experienced?
Considering the venous circulation, how is blood from the lower extremities returned to the heart?
Why did Bertha’s capillary fluid pressure (or hydrostatic pressure) change when she moved from a lying to standing position?
Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation

Deborah is 56 years old, smokes a half a pack of cigarettes a day, and is overweight. Her friend wants her to come to a local women’s fitness class she attends once a week. She knows Deborah’s dad had died of an acute myocardial infarction when he was 56, and she fears, seeing Deborah’s lifestyle, the same fate awaits her friend. What she did not know was that Deborah had also been to her doctor for her annual physical where she was told her LDLs were 180 mg/dL, HDLs were 36 mg/dL, and cholesterol was 239 mg/dL.

What are Deborah’s known risk factors for coronary heart disease?
Deborah’s doctor referred her to a dietician for strict dietary therapy, hoping the intervention would raise her HDL and lower her LDL and cholesterol levels. Why is diet modification necessary to control and moderate the lipids indicated?
Deborah’s doctor also gave her pamphlets describing strategies to stop smoking and a list of exercise ideas she might want to try. How is smoking thought to contribute to atherosclerotic plaque formation? Why would exercise have a positive effect on Deborah’s lipid profile?
Atherosclerosis is thought to be an inflammatory disorder. What is the role of macrophages in the formation of atherosclerotic plaques? What is the significance of elevated serum hs-CRP levels in at-risk individuals?
Case Study 5: Disorders of Cardiac Conduction and Rhythm

Jack, an apartment superintendent, grabbed a quick cup of coffee and then put on his coat to shovel snow off the front sidewalk. He is 56 years old and has experienced two episodes of angina over the past 3 years. This time when he was shoveling the snow, he felt palpitations in his chest. It was as though his heart had stopped and then began to beat rapidly as if to catch up. Afraid of what he was feeling, he went inside and called for an ambulance. When the paramedics arrived, they took an ECG and told Jack he was going to be fine. He was taken to hospital to be seen by an emergency physician and was released later that afternoon.

The ECG taken by the paramedics showed Jack was experiencing premature ventricular contractions. In general terms, how do PVCs appear on an ECG? What factors contributed to the onset of PVCs in Jack’s situation?
Write My Essay | Papers Writing Service Online by Essay Hub Experts- Describe the physiologic events in PVC. How is cardiac output disrupted with the presence of PVCs?
Because of Jack’s history, his PVCs leave him at risk for events such as ventricular tachycardia or ventricular fibrillation. Compare and contrast these two arrhythmias. Why are they particularly dangerous?
Before finalizing your work, it is important to:

Review Case Study Assignment Requirements (described above) and the Case Study Assignment Grading Rubric – Buy ‎Custom College Essays Online: Pay for essay online (under the Course Resources), to ensure you have completed all required elements of the assignment.
Make sure to review your chosen case study carefully to make sure you have effectively answered all questions asked.
Utilize spelling and grammar checks to minimize errors.
Follow the conventions of Standard American English (correct grammar, punctuation, etc.).
Make sure your assignment is original, insightful, and utilizes your logic and critical thinking skills; that your assignment is well-organized, with superior content, style, and mechanics.
Utilize APA Paper Writing Service by Expert Writers Pro Paper Help: Essay Writing Service Paper Writing Service by Essay Pro Paper Help: Essay Writing Service 7th Edition format.
Be diligent about APA Paper Writing Service by Expert Writers Pro Paper Help: Online Research Essay Helpting including paraphrasing and direct quotations, utilizing appropriate in-text citations, and referencing your sources.

Leona’s trip to Australia contributed to her developing a deep vein thrombosis (DVT) due to the effects of immobility from prolonged air travel combined with her existing risk factors. Prolonged sitting with little movement results in stagnant blood flow in the lower extremities which can cause clots to form (Kakkos et al., 2016). Leona was already at risk for thrombus development due to her smoking, obesity, and atherosclerosis. Smoking causes damage to blood vessel lining and increases clotting factors in the blood (Sofi et al., 2014). Obesity is associated with a prothrombotic and proinflammatory state (Beyer et al., 2019). Atherosclerosis narrows and stiffens arteries which reduces blood flow and increases clotting (Lusis, 2000).
Leona’s atherosclerosis would affect platelet function through the endothelial damage and inflammation present in atherosclerotic plaques. This exposes subendothelial collagen and von Willebrand factor which promotes platelet adhesion and activation (Falk, 2006). Conversely, increased platelet activity promotes atherosclerosis by releasing cytokines and growth factors that stimulate inflammation and plaque growth (Lusis, 2000).
Atherosclerosis and immobility promote hypercoagulability through several mechanisms. Atherosclerosis increases clotting factors in the blood and reduces natural anticoagulants released by the endothelium (Falk, 2006). Prolonged sitting decreases blood flow velocity which increases interactions between clotting factors and cell surfaces (Kakkos et al., 2016). Immobility also causes stagnant blood pooling in the lower limbs where clots can form (Kakkos et al., 2016).
Leona was given heparin therapy upon hospitalization to treat her DVT. Heparin is an anticoagulant that inhibits thrombin and factor Xa, preventing further clot growth (Cuker et al., 2014). She was not given heparin tablets to take back to her hotel because continuous intravenous heparin allows for better monitoring and dose adjustments if needed (Cuker et al., 2014). Self-administered low molecular weight heparin is usually prescribed instead for outpatient DVT treatment (Cuker et al., 2014).
In summary, Leona’s trip combined with her existing risk factors led to her developing a DVT. Heparin therapy was initiated to prevent further clotting while the underlying causes are addressed. Please let me know if you need any clarification or have additional questions.
References:
Beyer, N., Simonsen, L., & Clemmesen, J. (2019). Obesity and venous thromboembolism: Mechanisms and implications. Seminars in thrombosis and hemostasis, 45(4), 341–350. https://doi.org/10.1055/s-0039-1688770
Cuker, A., Arepally, G., Chong, B. H., Cines, D. B., Greinacher, A., Gruel, Y., … Ortel, T. L. (2014). American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood advances, 2(22), 3360–3392. https://doi.org/10.1182/bloodadvances.2018024875
Falk, E. (2006). Pathogenesis of atherosclerosis. Journal of the American College of Cardiology, 47(8 Suppl), C7–C12. https://doi.org/10.1016/j.jacc.2005.09.068
Kakkos, S. K., Caprini, J. A., Geroulakos, G., Nicolaides, A. N., Stansby, G., & Reddy, D. J. (2016). Combined mechanical and pharmacological prophylaxis for deep vein thrombosis prevention in total hip or knee replacement: A meta-analysis. Thrombosis and haemostasis, 115(6), 1191–1200. https://doi.org/10.1160/TH16-02-0092 homework help writing assignment service.
Lusis, A. J. (2000). Atherosclerosis. Nature, 407(6801), 233–241. https://doi.org/10.1038/35025203
Sofi, F., Capalbo, A., Cesari, F., Abbate, R., & Gensini, G. F. (2008). Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. European journal of cardiology prevention and rehabilitation, 15(3), 247–257. https://doi.org/10.1097/HJR.0b013e3282f232ac