Pathophysiology & Clinical Findings of the Disease Essay

Pathophysiology & Clinical Findings of the Disease Essay

Pathophysiology & Clinical Findings of the Disease Essay

1. Identify the correct hypersensitivity reaction

The case study scenario accurately depicts Allergic rhinitis/hay fever as the hypersensitive reaction. An allergic reaction to allergens is the root cause of allergic rhinitis. Although pollen is the most prevalent allergen, other prominent culprits include dust mites, dead skin cells from animals, and mildew (Cemar & Nuray, 2019). Allergic rhinitis is commonly diagnosed based on the patient’s history of symptoms such as sinus infections, runny nose, sneezing, nasal congestion, eye swelling and redness, conjunctival edema, and erythema (Seidman et al., 2015).

2. Explain the pathophysiology associated with the chosen hypersensitivity reaction

The four categories of allergic responses are as follows; IgE-mediated type 1 hypersensitivity reaction, Type 2 hypersensitivity is a reaction that takes place only in specific tissues, immune-complexes mediated Type 3 hypersensitivity reactions and the cell-mediated reaction. The type 1 hypersensitivity reaction causes allergic rhinitis (Cemar & Nuray, 2019). Re-exposure to the offending allergen causes the onset of its symptoms.

In allergic rhinitis, the allergen is introduced to a person with a hereditary susceptibility that leads to an allergic reaction. T helper cells facilitate antigen presentation, triggering B lymphocyte activation and sand maturity of plasma cells that produce IgE-specific antibodies to allergens (Cemar & Nuray, 2019). Moreover, memory cells are generated. The antibodies attach to IgE receptors on mast cells in the respiratory epithelium. The IgE antibodies also adhere to the basophils, leading to cell sensitization. Regular exposure to an allergen causes preexisting IgE antibodies to link together, activating mast cells, which then release histamine and other mediators of an allergic reaction (Cemar & Nuray, 2019). Stuffy nose, contraction of smooth muscles, swelling, and immediate inflammatory response all present as symptoms of allergic rhinitis, with histamine as the primary mediator of these reactions.

In this case, the study patient experienced symptoms of allergic rhinitis, such as nasal congestion. The allergen was absent when she went to the Caribbean, and the symptoms subsided. She re-experienced the symptoms when she returned home to her cat and dog. The cat is the most likely source of the allergens because her symptoms started appearing when it was adopted.

3. Identify at least three subjective findings from the case.

Subjective findings are collected from the patient’s verbal report. From the case presented, the patient reported experiencing sneezing, nasal stiffness, and rhinorrhea that ‘seems never to go away.

4. Identify at least three objective findings from the case.

The clinician observes objective findings during the assessment of the patient. The objective findings from the case study included redness and swelling of the eyelids, erythema, and swelling of the conjunctiva.

5. Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.

Allergic rhinitis can be treated with a variety of drugs. The first category of medications with high recommendations is corticosteroids, especially intranasal corticosteroids like fluticasone propionate and budesonide (Epocrates, 2022). Antihistamines, especially H1 receptor antagonizers like cetirizine and fexofenadine, are another highly recommended class (Epocrates, 2022).

6. Describe the mechanism of action for each of the medication classes identified above

The intranasal steroid is anti-inflammatory by decreasing inflammatory mediators like mononuclear cells, eosinophils and cytokines and as a potent vasoconstrictor (Seidman et al., 2015). The corticosteroid also decreases antigen-induced respiratory mucosal hyperactivity. A substantial amount of time, between 3 and 5 hours, is required for the drugs to begin action.

Conversely, antihistamines work by antagonizing the H1 receptors, which means they compete with histamine for the H1 receptors (Seidman et al., 2015). It counteracts histamine effects by decreasing secretions, redness, and edema. The onset of action usually takes 20 minutes to 1 hour.

7. Identify two treatment options that are NOT recommended (I.e., recommended against).

Oral leukotriene receptor antagonists like Zileuton are not recommended in managing allergic rhinitis because they have more adverse effects than antihistamines, such as suicidal ideations (Seidman et al., 2015). Increased imaging of the patient in the diagnosis of allergic rhinitis when they have apparent symptoms of the condition is discouraged due to the increased exposure to harmful radiation (Seidman et al., 2015).

References

Cemal, C., & Nuray, M. (2019). All Around the Nose. Springer Nature.

Epocrates (2022). Allergic rhinitis Key Highlights – Epocrates Online. Accessed on March 9^th from https://online.epocrates.com/diseases/232/Allergic-rhinitis

Seidman, D., Gurgel, K., Lin, Y., Schwartz, R., Baroody, M., Bonner, R., Dawson, E., Dykewicz, S., Hackell, M., Han, K., Ishman, L., Krouse, J., Malekzadeh, S., Mims, W., Omole, S., Reddy, D., Wallace, V., Walsh, A., Warren, E., & Wilson, N. (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–Head and Neck Surgery, 152(1_suppl), S1–S43. https://doi.org/10.1177/0194599814561600

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The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with Allergic Rhinitis. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

Analyze the case to arrive at the type of hypersensitivity reaction that the patient is exhibiting. (CO1)

Explain the pathophysiology of the identified hypersensitivity reaction. (CO1)

Identify all subjective and objective information provided in the case. (CO3)

Explain, using pathophysiology, the rationale for each subjective and objective finding. (CO1, CO3)

Identify two types of medications that are strongly recommended for the treatment of allergic rhinitis according to the clinical practice guidelines on the management of allergic rhinitis. (CO2, CO5)

Explain the mechanism of action of the two medication classifications and include how the symptoms of allergic rhinitis are alleviated when taken. (CO2, CO5)

Due Date

Sunday by 11:59 PM MT of Week 1

Total Points Possible

This assignment is worth 100 points.

Preparing the Assignment

Content Criteria:

Read the case study listed below.

Refer to the rubric for grading requirements.

Utilizing the Week 1 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.

You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.

You must use the Clinical Practice Guideline (CPG) for the management of allergic rhinitis to answer the treatment recommendation questions. The guideline can be found at the following web address: https://journals.sagepub.com/doi/10.1177/0194599814561600Links to an external site..You may also use a medication administration reference such as Epocrates to provide medication names.

Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

A 35-year-old woman presents to the primary care office with a history of nasal congestion that has worsened over time and recurrent sinus infections. She considered herself healthy until about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness that “seems to never go away”. She noticed that her rhinorrhea greatly improved when she attended her family reunion on a two-week Caribbean cruise but returned after being home a few days. She lives with her husband and 5- year-old child. They have two household pets: a dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago. Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema, allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and inflamed nares.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

Identify the correct hypersensitivity reaction.

Explain the pathophysiology associated with the chosen hypersensitivity reaction.

Identify at least three subjective findings from the case.

Identify at least three objective findings from the case.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.

Describe the mechanism of action for each of the medication classes identified above.

Identify two treatment options that are NOT recommended (I.e., recommended against).

ASSIGNMENT CONTENT
Category Points % Description
Pathophysiology & Clinical Findings of the Disease 45 45%

The student:

Identifies the correct hypersensitivity reaction.

Explains the pathophysiology associated with the chosen hypersensitivity reaction.

Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).

Identifies at least three subjective findings from the case.

Identifies at least three objective findings from the case.

(5 Required Elements)

Management of the Disease 45 45%

The student:

Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.

Identifies two strongly recommended medication classes for the treatment of the condition and provides an example (drug name) for each.

Describes the mechanism of action for each of the medications identified.

Identifies two treatment options that are NOT recommended (I.e.,recommended against).

90 90% Total CONTENT Points = 90 pts
ASSIGNMENT FORMAT
Category Points % Description
Organization, spelling, grammar & APA format 10 10%
The student:

Uses the week 1 case study template for case study responses.

Provides correct in-text citations for responses which match the reference page.

Has minimal spelling, grammar & APA format errors.

10 10% Total FORMAT Points = 10 pts
100 100% ASSIGNMENT TOTAL = 100 points

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Rubric

NR507 Week 1 Case Study

NR507 Week 1 Case Study

Criteria Ratings Pts
This criterion is linked to a Learning OutcomePathophysiology & Clinical Findings of the Disease
The student:

– Identifies the correct hypersensitivity reaction.

– Explains the pathophysiology associated with the chosen hypersensitivity reaction.

– Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).

– Identifies at least three subjective findings from the case.

– Identifies at least three objective findings from the case.

(5 Required Elements)

45 pts

All 5 required elements are present

41 pts
1 required element is missing.

37 pts
2 required elements are missing

23 pts
3-4 required elements are missing.

0 pts
All 5 required elements are missing.

45 pts

This criterion is linked to a Learning OutcomeManagement of the Disease
The student:

– Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.

– Identifies two strongly recommended medication classes for the treatment of the condition and provides an example (drug name) for each.

– Describes the mechanism of action for each of the medications identified.

– Identifies two treatment options that are NOT recommended (I.e., recommended against).

45 pts
All 4 elements are present

41 pts
1 required element is missing

37 pts
2 required elements are missing

23 pts
3 required elements are missing

0 pts
All 4 required elements are missing

45 pts

This criterion is linked to a Learning OutcomeOrganization, spelling, grammar & APA format
The student:

– Uses the week 1 case study template for case study responses.

– Provides correct in-text citations for responses which match the reference page.

– Has minimal spelling, grammar & APA format errors.

10 pts

Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 0-2 errors in spelling, grammar or APA format.

9 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 3-5 errors in spelling, grammar or APA format.

8 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 6-8 errors in spelling, grammar or APA format.

5 pts
Case study template is not used for responses OR In-text citations are incorrect or do not match the reference page AND There are 0-5 errors in spelling, grammar or APA format.

0 pts
Case study template is not used for responses AND/OR In-text citations are incorrect or do not match the reference page AND There are 6 or more errors in spelling, grammar or APA format.

10 pts

This criterion is linked to a Learning OutcomeLate penalty deductions
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.

0 pts
Manual Deductions

0 pts
Manual Deductions

0 pts

Total Points: 100

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