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Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders Case Study Analysis Jessica Pena Master of Science in Nursing, Walden University COURSE NURS 6501: Advanced Pathophysiology Dr. Akpati November 08, 2020

2 Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders Case Study Analysis A distressed 42-year-old man presents to the emergency department reporting dysuria, low back pain, inability to fully empty his bladder, severe perineal pain for the last 2 days, along with fevers, chills, and worsening pain. Upon assessment, his temperature is 104.0 F, pulse of 138, respirations 24 and PaO2 96% on room air. Digital rectal exam (DRE) reveals enlarged prostate, extremely tender, and warm to touch. This case analysis aims to identify factors that affect infertility, inflammatory markers in sexual transmitted disease (STD), why prostatitis and infection happens and the causes of systemic reaction, needs for a splenectomy after diagnosis of immune thrombocytopenic purpura (ITP), and the different kinds of anemia. Factors That Affect Fertility Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. Causes of male infertility may include medical, environmental, lifestyle, or a combination of issues. Medical factors that may cause infertility include abnormal sperm production or function, cryptorchidism and tumors (Harris, Fronczak, Roth, & Meacham, 2011). Certain diseases like diabetes and sexual transmitted infections such as chlamydia, gonorrhea, mumps, and/or HIV may also lower fertility. Low testosterone and genetic disorders are also associated with infertility. Low sperm counts can also be associated with extended exposure to chemicals, heavy metals, and radiation (Harris, Fronczak, Roth, & Meacham, 2011). Drug and alcohol use, tobacco, and stress have been associated with interfering with sperm production. Why Inflammatory Markers Rise in STD/PID When the body’s autoimmune response triggers inflammation certain proteins are then released into the bloodstream. Pelvic inflammatory disease (PID) is an infection of the women’s

3 reproductive system caused by colonization of the endocervix by microorganisms, which then ascend to the endometrium and fallopian tubes (Park et al., 2017). Inflammatory markers such as C-reactive protein (CRP), although nonspecific ESR, and CA-125, and WBC can be used to test for presence of inflammation (Park et al., 2017). Why Prostatitis and infection happens/Causes of Systemic Reaction Prostatitis is swelling and inflammation of the prostate gland which causes pain in the groin, dysuria, urinary frequency, and urinary retention (McCance & Huether, 2019). Acute bacterial prostatitis is often the cause of urinary tract infections, sexual transmitted diseases which include chlamydia and gonorrhea, and direct extension and lymphatic spread of rectal infection may cause prostatitis (McCance & Huether, 2019). A systemic response to any infection is when inflammation spreads from a localized area to another organ system in the body. Sepsis is most commonly associated with the systemic reaction of prostatitis, signs and symptoms include fever, severe pain and tenderness in the anoperineal area, nausea, emesis, and malaise (McCance & Huether, 2019). In immunocompromised individuals, systemic reactions of prostatitis can be caused by deep mycoses of opportunistic pathogens. Splenectomy After Diagnosis of ITP In patients with immune thrombocytopenia purpura (ITP), the immune system destroys platelets by producing antibodies that attach to platelets which destroy them, resulting in a bleeding disorder (McCance & Huether, 2019). Anti-platelet antibodies are shown to be produced in the spleen, removing the spleen may improve the number of platelets in circulating in the body. The decision of performing a splenectomy has to be made carefully as removing the spleen may increase the risk for infections and thrombosis. Before or after a splenectomy,

4 vaccinations against hepatitis B, pneumococcal infections, meningitis, and Hemophilus influenza will be given in an effort to protect against potential infections (McCance & Huether, 2019). Anemia Anemia is a medical condition where the body has insufficient healthy red blood cells carrying oxygen to the body tissues (National Heart Lung and Blood Institute (NHLBI), 2011 ). There are several types of anemia, the three general kinds of anemia are microcytic anemia, macrocytic anemia, and normocytic anemia. The classifications of anemia are based on size and hemoglobin content of the red blood cells. Microcytic anemia is the condition in which the red blood cells are smaller than usual. The smaller red blood cells can cause a lesser amount of oxygen as a result of having a lesser amount of hemoglobin. This specific condition is usually identified as microcytic hypochromic anemia. Common conditions for microcytic anemia are iron deficiency, thalassemia, and pregnancy (NHLBI, 2011). Normocytic anemia is the condition in which the red blood cells and hemoglobin are normal. The normality in red blood cells and hemoglobin usually suggests chronic diseases such as chronic kidney disease, cancer and chronic inflammatory diseases (NHLBI, 2011). Macrocytic anemia is the condition in which the red blood cell size is larger than usual and the hemoglobin remains normal. Impaired production and synthesis of red blood cells are most commonly the cause for Macrocytic anemia (NHLBI, 2011). Vitamin B12 and Folate deficiency, and the use of drugs such as Methotrexate are conditions that can cause Macrocytic anemia. While some issues are common for both men and women, certain infections and hematologic conditions might affect men and women primarily. In this case study, prostatitis is an infection affecting the prostate gland found in men. Prostatitis may include signs and

5 symptoms of infection, injury, or an immune disorder (McCance & Huether, 2019). Once the cause of prostatitis is identified the appropriate treatment plan can be carried out.

6 References: Harris, I., Fronczak, C., Roth, L., & Meacham, R. (2011). Fertility and the aging male. Retrieved from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253726/

McCance, K.L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. National Heart Lung and Blood Institute. (2011). Anemia In Brief. Retrieved from, https://my.clevelandclinic.org/health/diseases/3929-anemia

Park, S., Lee, S., Kim, M., Kang, Y., Moon, H., & Rhim, C. (2017). Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. Retrieved from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237214/...