Assignment: Adaptive Response

Assignment: Adaptive Response

Introduction

All humans are designed with two types of immunity; innate and adaptive. The innate immune system can distinguish between different classes of pathogens and recruit the most effective form of adaptive immune response to eliminate them. Adaptive responses are a response that the body adapts to certain injuries or insults. Innate responses are non-specific to the insult. Unlike innate immune responses, the adaptive responses are highly specific to the particular pathogen that induced them (Alberts et al, 2004). Injured tissue cells release chemicals that cause inflammation called “chemical mediators of inflammation.”  These chemicals primarily produce their effects in the localized areas where they are released (Alberts et al, 2004).  It is extremely important that health care professionals are familiar with innate and adaptive responses to correctly treat the condition and symptoms a presenting patient may be experiencing. Assignment: Adaptive Response.

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Pathophysiology and Alteration in Case Study #1

In case study number one the child’s body is reacting to a bacterial infection in the throat. When bacteria is introduced to the body it can stimulate an immune response (Huether & McCance, 2012).  Normally there is normal flora that prevents the bacteria from attacking the host. However, for many reasons the protective mechanism may be ineffective and then the body reacts to the virus or bacteria antigen. The virus or bacteria is the antigen that activates the complement system. The activation of the complement system causes the release of cytokines. The cytokines are the mediators responsible for the symptoms the child is experiencing. The cytokines that are specifically responsible for the symptoms are prostaglandins. The release of prostaglandins causes pain, fever and inflammation of the tonsillar tissue.  When released prostaglandins are able to reset the temperature control center in the brain thus, resulting in a fever.

Pathophysiology and Alteration in Case Study #2

In this case study the body activates the innate immune system. The skin which is the first line of defense senses a insult from the abrasive chemicals. After the injury from the chemicals the body activates its second line of defense (Huether & McCance, 2012). The result of the exposure to the chemicals results in a hypersensitivity. It is considered a type IV tissue specific type of hypersensitivity. These types of reactions are mediated by T lymphocytes. When the skin on the hands became exposed over a period of time a delayed cell mediated response was triggered.

Pathophysiology and Alteration in Case Study #3

In the third case study the patient is experiencing a reaction to the influence of stress over time. The stress response is complex and involves mechanisms of both protection and injury (Huether & McCance, 2012).    In this case, the patient is experiencing two types of stress: physiological and perceived stress. Assignment: Adaptive Response. Her history of hypertension is environmental stress. This is a type of chronic stress. The emotional stress of her mother’s broken hip triggers the stress response by the body. Assignment: Adaptive Response.When the alarm reaction occurs it results in an increased secretion by the adrenal medulla of glucocorticoids, epinephrine, and norepinephrine (Huether & McCance, 2012).  The release of those substances stimulates the “fight or flight” response. The secretion of those substances are the cause of her “racing heart rate’, decreased appetite and inability to sleep.

Conclusion

The pathophysiology of the bodies’ actual or perceived threat is a complex mechanism. It may serve as a mechanism for defense, adaptation or autoimmunity when its protective mechanisms become detrimental to the bodies maintenance of homeostasis. Activation of these systems and their adaptations may manifest in many ways. It is important to understand the physiology of the immune response to adequately and accurately treat the host. Assignment: Adaptive Response.

Mind Map

References

Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Chapter 24, The Adaptive Immune System. Available from: http://www.ncbi.nlm.nih.gov/books/NBK21070/

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

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Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. Assignment: Adaptive Response. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished. Assignment: Adaptive Response.
Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.
To Prepare
• Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
• Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
• Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.
• Review the Application Assignment Rubric found under Course Information
To Complete
Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:
• For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.
• Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.

Introduction

With the pathogen invasion, injury or any disease process our body defense mechanism gets activated by producing antibody, phagocytes and other complimentary response (Huether, & McCance, 2017). Understanding the process of adaptive response is important for advanced practice nurse to treat patient disease and alleviate the symptoms by recognizing the right pathophysiology behind it. The purpose of this paper is to discuss the pathophysiology and the compensatory mechanism (adaptive responses) and alterations of the disease processes and other factors that need consider for Scenario 1 diagnosis.

                                                          Scenario and Possible diagnosis

Jennifer is two year old girl presented with a temperature of 102.8, Heart rate of 128 beats per minutes and respiratory rate  of 24/minutes. On assessment cervical nodes are palpable and tender to touch on the left side further assessment revealed +4 tonsils with diffuse exudates. Clinical manifestation: Jennifer clinically presented with typical symptoms of acute bacterial tonsillitis include the following:

• Sore throat
• Swollen and very red tonsils with a yellowish coating
• Difficulty swallowing
• Fever over 38°C (100.4°F)
• Headache
• Fatigue and tiredness
• Loss of appetite
• Bad breath
• Swollen and painful lymph nodes in the neck

Tonsillitis can be caused by viral infection, typical cold symptoms such as a cough or a stuffy nose are likely too but there will be a low graded fever. On the other hand patient presented with pharyngitis have all this symptoms including inflammation of throats. So in above scenario Tonsilitis and dehydration secondary to poor appetite can be the most appropriate diagnosis based on the sign and symptoms.

Pathophysiology of Tonsillitis

Tonsillitis is an infection of tonsil gland caused by certain bacteria and virus. Mostly the bacteria and viruses spread through tiny droplets – in other words, when someone who is infected talks or sneezes, droplets containing the germs are released into the air (Huether& McCance, 2017). They can then come into contact with other people‘s mucous membranes, where they start multiplying.

The most common bacterial tonsillitis is caused by a specific type of streptococcus bacteria known as group A beta-hemolytic streptococcus (GABHS) (Huether& McCance, 2017). S pyogenes adheres to adhesion receptors that are located on the tonsillar epithelium (Shah, 2017). Immunoglobulin coating of pathogens may be important in the initial induction of bacterial tonsillitis. Sometimes tonsillitis occurs as a result of scarlet fever, which is also caused by bacteria. Viral infections like mononucleosis (also called “mono” or glandular fever) can lead to tonsillitis too. Assignment: Adaptive Response.

Epidemiology

Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than 2 years. In the above case scenario Jennifer is 2 years and at this age there are rare population are seen with bacterial tonsillitis.

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Differential Diagnosis:

As Jennifer in given scenario is just 2 years old it is good to rule out the infectious agent that cause tonsillitis. Consider infectious mononucleosis (MN) due to Epstein-Barr virus (EBV) in an adolescent or younger child with acute tonsillitis, particularly when it is accompanied by tender cervical, axillary, and inguinal nodes; splenomegaly; severe lethargy and malaise; and low-grade fever (Shah, 2017).A monospot serum test and rapid antigen test can be done to rule out and able to identify the causative agent (Shah, 2017).Throat culture help to choose provider the right sensitive antibiotic if indicated. In addition Complete blood Count and Basal metabolic panel may be necessary (Shah, 2017) Assignment: Adaptive Response.

Treatment

The main goal of treatment is to alleviate symptoms and prevent further complications. Antipyretic and analgesic drugs like ibuprofen or acetaminophen can help to alleviate pain and fever(PubMedHealth,2016).Antibiotic is standard treatment for treating  bacterial tonsillitis Throat lozenges, or using home remedies such as a neck wrap or gargling with salt water or tea can also help to alleviate the symptoms(PubMedHealth,2016).

Some people relieve their symptoms by sucking on Recurrent tonsillitis can also be treated with painkillers or antibiotics. The surgical removal of tonsils is a treatment option for people who frequently get tonsillitis(Shah, 2017) Assignment: Adaptive Response.

Summary

Clinical manifestations of disease processes can lead an advance practice nurse to begin to create the differential diagnosis of different pathologies of immune reactions their adaptive responses and associated alterations caused by a disease processes.  Studying immune responses allows for the advanced practitioner to think, accurately diagnosis and treat individuals critically.

Mind Map

References

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Tonsillitis: Overview. (2016, December 01). Retrieved March 07, 2018, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0090038/

Shah, U. (2017, December 15). Tonsillitis and Peritonsillar Abscess Workup. Retrieved March 07, 2018, from https://emedicine.medscape.com/article/871977-workup#c7 Assignment: Adaptive Response.