Case Study
Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a \u201ctickling\u201d cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent \u201ccolds\u201d every spring and fall.<\/p>\n
Physical Examination<\/p>\n
Vital Signs:\u00a0Afebrile; respiratory rate, pulse, and blood pressure all normal<\/p>\n
Skin:\u00a0Flaking erythematous rash on the flexor surfaces of both arms<\/p>\n
Head, Eyes, Ears, Nose, and Throat:\u00a0Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)<\/p>\n
Lungs: Clear to auscultation and percussion<\/p>\n
Initial Post:\u00a0Answer the following questions about Anna Sanchez and her condition.<\/p>\n
What evidence suggests that Anna does not have an acute severe infection?\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Anna\u2019s vital signs are within normal limits, and she is afebrile. She is not exhibiting abnormal heart or respiratory rate.\u00a0\u00a0<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n
If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?\u00a0\u00a0Type I hypersensitivity. \u201c\u00a0Type I (IgE-mediated) hypersensitivity reactions are mediated by antigen-specific IgE and the products of tissue mast cells3. Most common allergies (e.g., pollen allergies) are type I reactions. In addition, most type I reactions occur against environmental antigens and are therefore allergic. Because of this strong association, many healthcare professionals use the term allergy to indicate only IgE-mediated reactions\u201d\u00a0(McCance & Huether, 2019).\u00a0<\/p>\n
\u00a0<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n
A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna\u2019s roommate brought home a cat. Why didn\u2019t Anna\u2019s symptoms start when the cat entered the household, rather than 3 weeks later?\u00a0 \u201cIn some individuals, exposure to an environmental antigen causes primarily IgE production. Repeated exposure to the antigen usually is required to elicit enough IgE so that the person becomes \u201csensitized.\u201d IgE has a relatively short life span in the blood because it rapidly binds to very-high-affinity Fc receptors on the plasma membranes of mast cells\u201d\u00a0(McCance & Huether, 2019).\u00a0\u00a0During the early stage of the initial exposure to cat dander, Anna was becoming sensitized to the allergens in the dander. Anna\u2019s B lymphocytes were producing antibodies, which bound to the outer surface of mast cells.<\/p>\n
\u00a0<\/p>\n
What class of antibodies bind to the mast cells?\u00a0\u00a0IgE\u00a0<\/p>\n
\u00a0<\/p>\n
\u00a0<\/p>\n
What physiological mechanisms caused the redness of Anna\u2019s nasal mucosa?\u00a0The increased exposure to the\u00a0cat dander resulted in the cat danger allergens to bind to the IgE antibodies on mast cells. This caused the mast cells to degranulate and release inflammatory mediators. Some of the mediators caused vasodilation, which created the redness.<\/p>\n
\u00a0<\/p>\n
What mechanisms caused Anna\u2019s clear postnasal drainage?\u00a0Vasodilation and increased vascular permeability due to inflammatory mediators released by mast cells led to the postnasal drainage in Anna\u2019s case. \u201cMany local type I hypersensitivity reactions have two well-defined phases. The initial phase is characterized by vasodilation, vascular leakage, and, depending on the location, smooth muscle spasm or glandular secretions. These changes usually become evident within 5 to 30 minutes after exposure to the antigen. The late phase occurs 2 to 8 hours later without additional exposure to the antigen. The late phase has more intense infiltration of tissues with eosinophils, neutrophils, basophils, monocytes, and Th cells and tissue destruction in the form of mucosal epithelial cell damage. B, Activation of mast cells leading to degranulation of preformed mediators (primary mediators) and synthesis of newly formed (de novo) mediators (secondary mediators). ECF, Eosinophilic chemotactic factor; Fc, fragment crystallizable; Ig, immunoglobulin; IL, interleukin; NCF, neutrophil chemotactic factor; PAF, platelet-activating factor; Th, T-helper\u201d\u00a0(McCance & Huether, 2019).\u00a0\u00a0<\/p>\n
\u00a0<\/p>\n
\u00a0<\/p>\n
Reference<\/p>\n
McCance, K.L. & Huether, S.E. (2019). Cellular biology. In Brashers, V.L. & Rote, N.S. (Eds.),Pathophysiology: The biologic basis for disease in adults and children(8thed.). Elsevier.<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a \u201ctickling\u201d cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent \u201ccolds\u201d every spring and fall. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[10],"class_list":["post-89010","post","type-post","status-publish","format-standard","hentry","category-research-paper-writing","tag-writing"],"_links":{"self":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/89010","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/comments?post=89010"}],"version-history":[{"count":0,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/89010\/revisions"}],"wp:attachment":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/media?parent=89010"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/categories?post=89010"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/tags?post=89010"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}