Choose from the following hematologic diagnoses and outline a typical presentation, etiology, including risk factors, common differential diagnosis, typical diagnostic work-up, treatment plan, tertiary prevention measures and any nutritional needs, preventative measures, appropriate referrals, screening tools/diagnostic-specific scales tools (if any), and additional information that would be important to the geriatric population. Highlight differences in presentation of adult versus geriatric patients with this diagnosis. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
Anemia (iron deficiency, pernicious, B12, folic acid, anemia of chronic disease)
Thalassemia
Sickle-Cell Disease
Idiopathic Thrombocytopenic Purpura (ITP)
Heparin Induced Thrombocytopenia (HIT)
Disseminated Intravascular Coagulation (DIC).
Sample solution
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
Thalassemia
Typical Presentation: Thalassemia is a group of inherited blood disorders characterized by abnormal hemoglobin production. The typical presentation of thalassemia includes:
- Fatigue and weakness
- Pale skin (pallor)
- Slow growth and delayed puberty in children
- Enlarged spleen and liver
- Facial bone deformities (in severe cases)
- Shortness of breath
- Jaundice (yellowing of the skin and eyes)
Etiology and Risk Factors: Thalassemia is caused by genetic mutations that affect the production of hemoglobin. It is most commonly inherited in an autosomal recessive pattern, meaning an affected individual must inherit two abnormal genes – one from each parent. Risk factors for thalassemia include having a family history of the disorder, belonging to certain ethnic groups (Mediterranean, African, Southeast Asian, and Middle Eastern), and parental consanguinity.
Common Differential Diagnosis: The common differential diagnosis for thalassemia includes other causes of anemia such as iron deficiency anemia, anemia of chronic disease, and other hemoglobinopathies such as sickle cell disease.
Typical Diagnostic Work-Up: The diagnostic work-up for thalassemia includes:
- Complete blood count (CBC) to assess red blood cell indices (e.g., mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration [MCHC]).
- Hemoglobin electrophoresis to identify the specific type of thalassemia and differentiate it from other hemoglobinopathies.
- Genetic testing to confirm the diagnosis and identify specific gene mutations.
Treatment Plan: The treatment plan for thalassemia depends on the severity and type of thalassemia. Options may include:
- Regular blood transfusions to maintain adequate hemoglobin levels.
- Chelation therapy to remove excess iron from the body due to frequent blood transfusions.
- Folic acid supplements to support red blood cell production.
- Bone marrow transplant in severe cases.
Tertiary Prevention Measures and Nutritional Needs: Tertiary prevention measures for individuals with thalassemia include:
- Regular monitoring of iron levels and organ function.
- Vaccinations to prevent infections.
- Genetic counseling for individuals and their families to understand the inheritance pattern and make informed reproductive decisions.
Nutritional needs for individuals with thalassemia may include:
- A balanced diet rich in iron, vitamin C, and folic acid to support red blood cell production.
- Calcium and vitamin D supplements to prevent bone density loss in cases of expanded bone marrow.
Appropriate Referrals: Appropriate referrals for individuals with thalassemia may include:
- Hematologist or pediatric hematologist for specialized care.
- Genetic counselor for counseling regarding inheritance patterns and family planning.
- Support groups or mental health professionals to address emotional and psychosocial needs.
Additional Information Important to the Geriatric Population: In the geriatric population, thalassemia may present with additional challenges due to aging-related factors such as comorbidities, reduced organ function, and polypharmacy. Close monitoring of organ function, particularly liver and kidney function, is important in this population. Geriatric individuals may also have different nutritional needs and require individualized treatment plans considering their overall health status. Comprehensive assessment and regular follow-up are crucial to ensure optimal management of thalassemia in the geriatric population.
References:
- De Sanctis V, Soliman AT, Elsedfy H, et al. Thalassemia intermedia: revisited. Mediterr J Hematol Infect Dis. 2020;12(1):e2020032.
- Cao A, Galanello R. Beta-thalassemia. Genet Med. 2010;12(2):61-76.
