NURS 6501 Week 4 Assignment Case Study Analysis

NURS 6501 Week 4 Assignment Case Study Analysis

NURS 6501 Week 4 Assignment Case Study Analysis

Case Study

Cardiovascular and cardiopulmonary problems often affect a significant percentage of the global populations. Nurses and other healthcare providers have a critical role to play in ensuring that optimal care is offered to patients suffering from pulmonary and cardiac issues. They utilize evidence-based interventions to ensure the actual and potential needs of the patients are met. Therefore, this paper explores a case study of an 11-year-old boy who is experiencing cardiopulmonary and cardiovascular health problem.

Cardiovascular and Cardiopulmonary Pathophysiologic Processes

The patient in the case study appears to experience exercise-induced asthma and has allergic reaction towards cat dander. During exercise, the cardiac stroke volume and heart rate increases significantly to raise the cardiac output. There is also an increase in the mean arterial blood pressure due to rise in the systemic vascular resistance. The respiratory system also responds to the cardiac changes by increasing the respiratory rate and tidal lung volume. The increased ventilation during the exercise causes water loss from the surfaces of the airways through evaporation causing dehydration.

The dehydration causes contraction of the bronchial smooth muscles, reduction in the liquid volume of the epithelium and mast cell degranulation. As a result, the mast cells are stimulated to release inflammatory mediators such as tryptase, histamine, leukotrienes, and prostaglandins that cause smooth muscle contraction, increased mucus production, and narrowing, hence, exercise induced asthma (Aggarwal et al., 2018; Nystoriak & Bhatnagar, 2018).

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The other pathophysiologic mechanism contributing to the processes is the activation of IgE. The boy in the case study is allergic to cat dander. An exposure to the allergen stimulates the IgE. The stimulation of IgE results in the massive release of inflammatory mediators such as mast cells, prostaglandins, histamines, and leukotrienes. The production of mucus and inflammation of the airways accompany the release of inflammatory cells, hence, the symptoms following the exposure of the boy to cat dander (Bush, 2019; Sinyor & Concepcion Perez, 2021).

Racial/Ethnic Variables

Racial or ethnic variables may affect the physiological functioning and response to asthma treatment. For example, studies have shown that bronchodilator response to short-acting beta-agonists used in asthma treatment is below the expected responsiveness among Puerto Ricans of all ages and children from African American ethnicity. African Americans of all ages have also been shown to respond better to combined therapy for asthma when compared to European Americans. As a result, combined therapy shows enhanced effectiveness in treating asthma exacerbations in African American patients of all ages (Zhang et al., 2019).

The socioeconomic factors also tend to influence the physiologic response and treatment outcomes for asthma in children from different racial and ethnic communities. Accordingly, the prevalence and worse outcomes of childhood asthma has been shown to be high in children from ethnic minorities and poor backgrounds. Factors such as poor treatment adherence, low utilization of preventive and treatment services, and unaffordable care for asthma exacerbations increase the risk of hospitalizations and worse outcomes among the affected children. Besides asthma, children from low socioeconomic backgrounds are increasingly predisposed to other health problems such as obesity, which worsen the racial or ethnic disparities in asthma (Vazzalwar et al., 2019).

Interaction of Processes

The aforementioned processes interact to cause the symptoms that the boy is presenting to the hospital. For example, engaging in intensive exercises causes dehydration of the cell surfaces of the airway, reduction in epithelial liquid volume, and degranulation of the mast cells. The mast cells release inflammatory cells that increase mucus production and inflammation of the airways to cause symptoms of asthma such as wheezing, chest pains, and difficulties in breathing (Aggarwal et al., 2018). Besides, the exposure to cat dander stimulates the IgE to active the production of inflammatory cells, hence, increased mucus production, airway narrowing, and hyper-responsiveness to cause the symptoms of asthma (Bush, 2019). It is anticipated that the symptoms and outcomes of treatment would be worse in children from low socioeconomic backgrounds and ethnic minority groups due to barriers in accessing and utilizing the needed care.

Conclusion

The boy in the case study is experiencing exercise induced asthma and asthma due to exposure to an environmental allergen. The exposures increase the release of inflammatory cells such as cytokines that cause excessive mucus production and narrowing of the airways. Racial and ethnic variables may affect the physiological processes in asthma. Therefore, treatment should focus on preventing exacerbations of asthma in the future.

References

Aggarwal, B., Mulgirigama, A., & Berend, N. (2018). Exercise-induced bronchoconstriction: Prevalence, pathophysiology, patient impact, diagnosis and management. Npj Primary Care Respiratory Medicine, 28(1), 1–8. https://doi.org/10.1038/s41533-018-0098-2

Bush, A. (2019). Pathophysiological Mechanisms of Asthma. Frontiers in Pediatrics, 7, 68. https://doi.org/10.3389/fped.2019.00068

Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular Effects and Benefits of Exercise. Frontiers in Cardiovascular Medicine, 5, 135. https://doi.org/10.3389/fcvm.2018.00135

Sinyor, B., & Concepcion Perez, L. (2021). Pathophysiology Of Asthma. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK551579/

Vazzalwar, N., Totapally, B., & Totapally, M. (2019). Racial/Ethnic Disparities Among Children with Asthma Discharged from the Hospital. Pediatrics, 144(2 MeetingAbstract), 508–508. https://doi.org/10.1542/peds.144.2_MeetingAbstract.508

Zhang, E., Levin, A. M., & Williams, L. K. (2019). How does race and ethnicity effect the precision treatment of asthma? Expert Review of Precision Medicine and Drug Development, 4(6), 337–356. https://doi.org/10.1080/23808993.2019.1690396

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

Photo Credit: yodiyim – stock.adobe.com

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

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In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.

Any racial/ethnic variables that may impact physiological functioning.

How these processes interact to affect the patient.

By Day 7 of Week 4

Submit your Case Study Analysis Assignment by Day 7 of Week 4

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The 16year old boy presented to the clinic with complaints of a sore throat for 3 days and his physical exam revealed that he was running a low-grade temperature of 99.6F. On examination, it was found that he has a reddened, posterior pharynx with swollen tonsils that has white exudates. He tested positive for strep throat. The cells around the tonsils have been altered because they tried to adapt to the injury of a foreign body. According to McCance & Huether (2019, p.47), cells protect themselves from injury by adapting to the environment(of the cell) to try to maintain a normal state or homeostasis. Cellular adaptations could be easily reversed but if this is not reversed, it could lead to injury or even cell death. With any infection or injury to cells and tissues, there are defense mechanisms the body exhibits, one of which is the inflammatory response, and others are the adaptive, and immunity responses (McCance & Huether, 2019, p.216).

The Role of genetics

Strep throat is caused by Streptococcus pyogenes (group A Streptococcus, GAS). This is a highly communicable disease, especially in children.  Strep throat is a bacterial infection that forms pus on the tonsils and if not treated can lead to death. Elf et al. (2018) in their research said that strep throat infection accounts for  20-30% of sore throat hospital visits in adults and children. When cell membranes are altered by gene disorders, this affects the shape, membrane structure, and transport mechanism of the cell making them more vulnerable to cell injury and infection. Recurrent infections suggest that the child is susceptible to that infection or disease and has low immunity to fight the bacteria, bacteria stay in the upper respiratory tract and just reinfect the host.    It is worth knowing that Genetics plays a role in these communicable infections or diseases, and environmental factors play their role too.

Presenting Specific Symptoms

The 16-year-old presented with these symptoms; a low-grade fever of 99.6F reddened posterior pharynx with white exudates on the tonsils, and enlarged tonsils up to 3+.  Cells adapt to their environment when there is a foreign body or infection to protect and escape themselves from any injury. According to McCance & Huether( 2019, p 84)), cellular swelling is an early manifestation of any cellular injury, this happens when there is a shift of extracellular water into cells, and this always manifests with fever.  The foreign pathogen in this boy’s cells manifested as a swelling or inflammation of the tonsils, which was tested and confirmed to be a Streptococcal infection. The administration of  500mg of Amoxicillin which was supposed to help clear this infection unfortunately resulted in an anaphylactic reaction. He had swollen tongue and lips, difficulty breathing, and audible wheezing, all indicative of an allergic reaction to the medication Amoxicillin.

The Physiologic Response to the Stimulus and why the Response Occurred

The tonsils are swollen because of vasodilation and the accumulation of increased amounts of various substances in the injured cells. The tonsils get inflamed, and the body tries to fight this infection. This is followed by pain, which is the reason the boy complained of sore throat, and the tonsils were red and inflamed on examination. The exudates on the tonsils are a result of many leukocytes that have accumulated because of the persistent bacterial infection, so pus is formed (McCance & Huether, 2019, p.210).

Amoxicillin is a penicillin derivative that can cause anaphylactic reactions which are IgE-mediated and is a medical emergency. With the hypersensitivity to Amoxicillin,  immunoglobulin (Ig) E is produced, and it binds to the receptors on mast cells and basophils (Justiz-Vaillant & Zito, 2019), furthermore, there is an activation and granulation of mast cells mediators. These mediators like histamine and lipid mediators cause an allergic reaction. If this reaction is not treated, this ultimately leads to laryngeal edema, shock, hypotension, and shock. Anaphylactic reactions should always be emergently treated.

The Cells Involved in this Process.

With the initial infection, the body produces granulocytes which are neutrophils, eosinophils, monocytes,  macrophages, and basophils that help in phagocytosis. This is the ingestion of any foreign body or dead cells in the cell and the disposal of them to help boost immunity. The neutrophils are the predominant ones at the initial stage of inflammation, they ingest bacteria and any dead cells while the eosinophils are the fighters and defenders of cells (McCance & Huether, 2019 p. 206 ). During this initial infection stage,  inflammation, a fever response, and leukocytosis happen. Leukocytosis is an increase in the number of circulating leukocytes or white blood cells that fight infections, additionally, plasma proteins are also produced to help fight infections. These proteins circulate in the body within 10 to 40 hours of any infection (McCance & Huether, 2019, p. 210), which would be the streptococcus bacteria in this scenario.

How Another Characteristic (e.g., gender, genetics) Would Change the Response 

Genetics plays a role in some infections or disease processes, this is because genes are passed on to descendants in all families. Sometimes genes mutate or are altered, which makes the host susceptible to diseases. Environmental factors can also play a part in the infection or disease process. Xu et al., (2022), in their research, found that non-genetic factors would influence the risk of most diseases. To help change the responses, gene testing should have been performed, this will help determine if the 16year old boy has any variation or mutation in his genes which would make him susceptible to a strep throat infection. Additionally, some genes are known to be susceptible to some medications, and if the 16years old was tested for drug sensitivity earlier in his life, the test would have told if his gene has a negative or positive response to  Amoxicillin.

 

References

Elf, S., Olli, J., Hirvonen, S., & Eboigbodin, K. E. (2018). Molecular Detection of Streptococcus pyogenes by Strand Invasion Based Amplification Assay.        Molecular Diagnostics & Therapy,22(5)595-602.DOI:10.1007/s40291-018-03468.     https://www.proquest.com/docview/2193094270?  accountid=14872Links to an external site.

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK513315/Links to an external site.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Xu, Y., Wang, C., Li, Z., Cai, Y., Young, O., Lyu, A., & Zhang, L. (2022). A machine learning model for disease risk prediction by integrating genetic and non-genetic factors. 2022 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), Bioinformatics and Biomedicine (BIBM), 2022 IEEE International Conference On, 868–871. https://doi.org/10.1109/BIBM55620.2022.9994925Links to an external site.

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