1228. Case Study 1 & 2 Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle. Case Study 1 & 2 Lyme Disease and Peripheral Vascular Disease The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submitted in this course are registered and saved in turn it in program. Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted. Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement. All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites) per case Study Lyme Disease Case Study # 1 A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patients symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: Studies Result Lyme disease test: Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR):30 mm/hour (normal: ?15 mm/hour) Aspartate aminotransferase (AST): 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb); 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct); 36% (normal: 42%-52%) Rheumatoid factor (RF): Negative (normal: negative) Antinuclear antibodies (ANA): Negative (normal: negative) Diagnostic Analysis: Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. Critical Thinking; Questions 1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment. Peripheral Vascular Disease Case Studies #2 A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patients popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg. Studies Results Routine laboratory work: Within normal limits (WNL) Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure) Arterial plethysmography: Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves Femoral arteriography of right leg: Obstruction of the femoral artery at the midthigh level Arterial duplex scan: Apparent arterial obstruction in the superficial femoral artery Diagnostic Analysis: With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic. Critical Thinking Questions: 1. What was the cause of this patient’s pain and cramping? 2. Why was there decreased hair on the patient’s right leg? 3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation? 4. What would be the treatment of intermittent Claudication for non-occlusion?