NURS 6501 Module 2 Assignment Case Study Analysis

This week we will have another scenario to base our assignment on it is listed below:

A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations.

On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF).

Using the above mentioned scenario you are to complete a knowledge check. Per the instructions: You will complete a 10- to 20-question Knowledge Check to gauge your understanding of this module’s content.
This Knowledge Check will give you an opportunity to review a given scenario or situation to help you to determine cause and effect of a given disorder from a pathophysiology perspective. Please note that this is a formative practice for you to help you better prepare for your Midterm and Final Exams.

Please reach out if you have any questions.

NURS 6501 Week 2: Altered Physiology

With a place squarely in the spotlight for patients diagnosed with all manner of disease, APRNs must demonstrate not only support and compassion, but expertise to guide patients’ understanding of diagnoses and treatment plans.

This expertise goes beyond an understanding of disease and sciences, such as cellular pathophysiology. APRNs must become experts in their patients, understanding their medical backgrounds, pertinent characteristics, and other variables that can be factors in their diagnoses and treatments.

This week, you examine alterations in the immune system and the resultant disease processes. You consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.

Learning Objectives for NURS 6501 Module 2 Assignment Case Study Analysis

Students will:

Evaluate cellular processes and alterations within cellular processes
Analyze alterations in the immune system that result in disease processes
Identify racial/ethnic variables that may impact physiological functioning
Evaluate the impact of patient characteristics on disorders and altered physiology

Alterations Within Cellular Process Example Paper

A 16-year-old boy comes to the clinic with the chief complaint of a sore throat for three days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections, or pneumonia. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78, and regular respirations of 18. HEENT normal with the exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy.

Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg PO q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips and difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

In the aforementioned case study, the patient presented with acute pharyngitis. Pharyngitis refers to the inflammation of mucus membranes of the oropharynx. Manifestations of uncomplicated pharyngitis include fever, painful cervical adenopathy, tonsillar exudates, and pharyngeal erythema (Wolford et al., 2022). It is predominantly caused by viral or bacterial infectious processes. A positive rapid strep test, in his case, favors a bacterial etiology.

According to Wolford et al. (2022), Group A beta-hemolytic streptococci is the most common cause of bacterial acute pharyngitis and accounts for up to 36% of the cases. Subsequently, the boy has been prescribed antibiotics, principally amoxicillin which is recommended for bacterial eradication in patients with strep pharyngitis. Upon taking the first capsule, the patient develops an immediate hypersensitivity reaction.

Genetics

The patient in the case study above is allergic to penicillin. Type 1 hypersensitivity reactions include atopic diseases, which run in families. Drug hypersensitivity reactions can be allergic or non-allergic. However, these reactions usually occur as a result of cumulative interaction and interplay of various environmental and genetic factors.

For instance, more than half of children born in atopic families develop an allergic disease as opposed to one in five children with no family history of allergies (Amo et al., 2019). Additionally, various genes act diversely in different families to predispose to drug hypersensitivity reactions. For instance, the PHF11 gene on chromosome 13q14 has been linked consistently with drug hypersensitivity reactions.

Specific Symptoms, Why, and Physiologic Response

The patient presented with swelling of lips and tongue, difficulty breathing, and audible wheezing. Swelling of the lips and tongue are characteristics of allergic angioedema. According to Justiz Vaillant et al. (2022), allergic angioedema is a type 1 hypersensitivity reaction and can be triggered by foods such as nuts and medications such as penicillin.

In this scenario, the patient has an exaggerated immune response in response to amoxicillin. Severe angioedema may progress to anaphylaxis. The difficulty in breathing and audible wheezing are a result of histamine-mediated bronchoconstriction. If not treated, the patients usually develop anaphylactic shock, which is life-threatening and may lead to death.

Involved Cells and the Process

According to McCance and Huether (2019), type 1 hypersensitivity reactions are IgE- mediated and involve the release of large amounts of histamines and later leukotrienes by mast cells. Immune cells that are involved in this allergic reaction are T helper cells of types 1, 2, and 17. T helper 1 cells produce IL-2 and interferon-gamma and enhance a cell-mediated immune response, while T helper 2 cells produce IL-4 and IL-13, which enhance the production of antigen-specific-IgE.

Meanwhile, T helper 17 cells produce IL-17, IL-21, and IL-22. The drug is presented to these T cells via dendritic cells. Finally, the antigen binds to TCR receptors on the T cells and activates these immune cells (McCance & Huether, 2019).

Gender and other characteristics such as age, genetics, geography, and race influence the distribution of allergic diseases such as hypersensitivity reactions. For instance, most of these reactions are highly prevalent in childhood. In the United States, Puerto Ricans have the topmost prevalence, followed by blacks, whites, Asians, and ultimately Mexicans.

References

Amo, G., Martí, M., García-Menaya, J. M., Cordobés, C., Cornejo-García, J. A., Blanca-López, N., Canto, G., Doña, I., Blanca, M., Torres, M. J., Agúndez, J. A. G., & García-Martín, E. (2019). Identification of novel biomarkers for drug hypersensitivity after sequencing of the promoter area in 16 genes of the Vitamin D pathway and the high-affinity IgE receptor. Frontiers in Genetics, 10, 582. https://doi.org/10.3389/fgene.2019.00582

Justiz Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513315/

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biological basis for disease in adults and children. Elsevier.

Wolford, R. W., Goyal, A., Syed, S. Y. B., & Schaefer, T. J. (2022). Pharyngitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519550/

NURS 6501 Module 2 Assignment Case Study Analysis