Submission Instructions: You Must complete both case studies when there are more

Submission Instructions:

You Must complete both case studies when there are more than one.

• This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years.
• You should respond to your peer by extending, refuting/correcting, or adding additional nuance to their posts. Must have intext citation and one reference, and 150 words.
• All replies must be constructive and use literature.

Grading Rubric

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Your assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria	Ratings	Points
Identification of Main Issues, Problems, and Concepts	Distinguished – 5 points Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.	Excellent – 4 points Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.	Fair – 1-3 points Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.	Poor – 0 points Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.	5 points
Use of Citations, Writing Mechanics, and APA Formatting Guidelines	Distinguished – 3 points Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.	Excellent – 2 points Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.	Fair – 1 point Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.	Poor – 0 points Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.	3 points
Response to Posts of Peers	Distinguished – 2 points Student constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.		Fair – 1 point Student constructively responded to one other post and either extended, expanded, or provided a rebuttal.	Poor – 0 points Student provided no response to a peer’s post.	2 points
Total Points					10

Urinary Function Case Study

Types of Acute Kidney Injury (AKI) and Clinical Manifestations

Per the clinical manifestations outlined, Mr. J.R. could be suffering from either of the two types of Acute Kidney Injury (AKI). The patient’s pre-renal AKI could be happening because of symptoms like nausea, vomiting, diarrhea, and inability to tolerate fluids. Those symptoms are signs of dehydration and hypovolemia that may lead to renal ischemia and subsequent kidney failure. The vertigo and dizziness allied with weakness after standing up may indicate the presence of severe dehydration. Since AKI could be of two types- either intrinsic or superimposed, the metallic taste in the mouth and the possibility of damage to renal parenchyma or tubules could be proof of direct damage to these organs (Ronco et al., 2019). Gastroenteritis may be a significant cause that allows the bacteria or toxins to go into the bloodstream, and the ATN, a type of intrinsic AKI, would be the result. Although it is not explicitly expressed, in renal AKI, it is also possible after urinary tract obstruction that cannot be omitted using the given data.

Potential Risk Factors

The multifactorial Mr. J.R. might be exposed to many risk factors for the disease of AKI. His age of 73 years is sufficient evidence that he has to deal with age-associated renal changes and reduced renal reserves, with which comes all these risks (Harrios et al., 2018). The loss of fluids from vomiting and diarrhea contributed to the feeling of nausea, which has probably led to substantial imbalances in fluids and electrolytes and increased risk for kidney damage. Moreover, the coincident onset of symptoms after the intake of burritos that can cause foodborne illness can result in AKI through several mechanisms like toxins exposure, sepsis, and gastrointestinal inflammation. The case does not reveal whether there is any single underlying medical condition. Still, conditions such as diabetes, hypertension, or cardiovascular disease can also be the risk factor for AKI development.

Complications of Chronic Kidney Diseases (CKD) in the Hematic System.

If Mr. J.R.’s kidney injury turns irreversible, he might potentially develop chronic kidney disease (CKD). Consequently, he may face complications with the blood-related system that include low platelets or anemia. An imbalance in erythropoietin secretion caused by chronic renal failure leads to anemia and diminished production of platelets (thrombocytopenia). Not only that but uremic toxins are also known to be able to alter the platelet function and disturb the coagulation cascade, which leads to coagulopathy with bleeding issues such as easy bruising and prolonged bleeding times. Impaired kidneys, too, have diminished production of erythropoietin. In addition, red blood cell production is hampered as the anemia sets in, manifesting itself as fatigue, weakness, pallor, shortness of breath, and almost cardiovascular complications.

Reproductive Function Case Study

Probable Diagnosis and Explanation

The given clinical manifestations (lower abdominal pain, nausea, emesis, heavy malodorous vaginal discharge) and microscopic examination results (presence of white blood cells and gram-negative intracellular diplococci) indicate that the most probable diagnosis of Ms. P.C., a 19-year-old female patient, would be Gonorrhoea. Being gram-negative intracellular diplococci in vaginal discharge is highly specific and characteristic of Neisseria gonorrhea, which is the common cause of gonorrhea (Pérez‐Gracia & Suay‐García, 2018). The bacterium Neisseria gonorrhoeae is a gram-negative diplococci pathogen, and it is an STD (sexually transmitted infection); the identification of this bacterium within the white blood cells stained in the vaginal discharge sample strongly supports this diagnosis.

Thus, the typical clinical manifestations of lower abdomen pain, nausea, vomiting, and stinking, yellowish-green discharge are female gonorrhea. The patient might get exposed to gonorrhea and complain of cervicitis or pelvic inflammatory disease (PID), which are accompanied by these symptoms. It also becomes essential to note that the report from the patient’s previous sexual intercourse without protection with one partner and no previous genitourinary infection or sexually transmitted disease point out a new sexually transmitted infection like gonorrhea.

Likely Microorganism Involved

According to the microscopic examination results, which had identified gram-negative intracellular diplococci organisms, the microorganism most probably responsible for Ms. P.C.’s infection is Neisseria gonorrhoeae. This gram-negative, diplococcic bacterium is the etiological agent of gonorrhea, a sexually transmitted disease (Quain et al., 2024). The gonococcal (Neisseria gonorrhoeae), a fastidious organism, has a unique capacity for intracellular survival and multiplication within the host’s white blood cells (neutrophils). This distinctive morphology of gram-negative bacteria confirms this microorganism’s involvement in Ms. P.C.’s infection.

Criteria for Hospitalization

For Ms. P.C., hospitalization may be necessary considering the possible aspects mentioned below. In turn, the patient experiences the height of the infection, such as PID, sepsis, and other complications caused by the gonorrhea infection, requiring the patient to be hospitalized for intravenous antibiotic treatment and constant observation. If Ms. P.C.’s pregnancy progresses and she experiences premature labor, chorioamnionitis, or gives birth to an infected child, hospitalization should be considered before complications can develop. Moreover, in the case of a patient who has unbearable vomiting and nausea to tolerate oral antibiotics, the use of intravenous antibiotics needs hospitalization. No follow-up will be done if the patient thinks they can’t follow the mentioned treatment regimen. Hospitalization is necessary to avoid further transmission of the disease. To the outcome of her condition, Ms. P.C. will require hospitalization if she has co-infections with other sexually transmitted diseases or develops perihepatitis (Fitz-Hugh-Curtis syndrome) or pelvic inflammatory disease. However, it is pertinent to mention that on many occasions, outpatient treatment with antibiotic therapy is a sufficient remedy for uncomplicated gonorrhea. Still, the hospitalization decision should be made after assessing the patient’s condition, existing complications, and treatment compliance possibilities.

References

Pérez‐Gracia, M. T., & Suay‐García, B. (2018). Gonorrhea. Diagnostics to Pathogenomics of Sexually Transmitted Infections, 181-209.

Qian, L., McSheffrey, G. G., Gray-Owen, S. D., Zhang, J. R., & Tang, Y. W. (2024). Neisseria gonorrhoeae. In Molecular Medical Microbiology (pp. 1357-1378). Academic Press.

Ronco, C., Bellomo, R., & Kellum, J. A. (2019). Acute kidney injury. The Lancet, 394(10212), 1949-1964.

Harrois, A., Soyer, B., Gauss, T., Hamada, S., Raux, M., Duranteau, J., & Traumabase® Group jduranteau@ me. com Olivier Langeron Catherine Paugam-Burtz Romain Pirracchio Bruno Riou Guillaume de Saint Maurice Xavier Mazoit. (2018). Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study. Critical Care, 22, 1-10.