NR 507 Week 6 – Discussion Post
In this case scenario, it is noted that the 12-year-old boy does not have significant allergies or medical history that may have caused his hives and urticaria. Therefore, I think that the probable cause of his hives and urticaria is stress from soccer practice. There are multiple works of literature about stress-induced urticaria; one of them was published by Tareen & Tareen (2016). According to Tareen & Tareen (2016), stress can cause different things in our human body, including hive and urticaria. The signs and symptoms of stress-induced urticaria, according to Tareen & Tareen (2016), include superficial larger size hives with itching on the body or any other part of the body but do not cause lips, tongue, or throat to swell. In addition, according to Tareen & Tareen (2016), hives and urticaria show up when an affected individual is stressed from school work, relationships, work, or playing sports. This case scenario shows that all the signs and symptoms identified by Tareen & Tareen (2016) are parallel to the 12-year-old boy’s diagnosis and the event that caused the flare-up of his hives and urticaria (Tareen & Tareen, 2016).
Henning et al. (2014) identified that urticaria and dermal edema are caused by leakage of fluid into the dermis area due to vascular dilation in response to the molecules that are released by mast cells. In addition, urticaria is the result of the active state of the mast cells. These mast cells are found around the small blood vessels locally on the dermis of the skin and mucosa that react to histamine (preformed mediators). The role of the mast cells is to provide the first line of defense from parasites and microorganisms. “Mast cell activation induces vasodilatation and vasopermeation, leading to dermal edema and the recruitment of humoral and cellular immune effectors” (Hennino et al., 2014, para. 2). In this situation, the signs and symptoms that the 12-year-old boy is currently experiencing are the result of the activation of the mast cells reacting to the stimuli, such as the stress from soccer practice (Hennino et al., 2014).
According to====, the relationship between the 12-year-old boy’s symptoms and the concept of inflammation is relatively significant., According to=====, hives are reactions in response to preformed mediators (the 12-year-old boy was noted to have hives on assessment). In contrast, urticaria is feeling itchy due to the release of histamine and other chemicals found within the surface of the skin reacting to allergen molecules. Therefore, the “bumps” or wheals noted on the 12-year-old body are a form of inflammation and fluid accumulation under the skin caused by the chemicals and histamine released from the surface skin of the body.
NR 507 Week 6 – Discussion Post
There are different treatments for acute urticaria, including pharmacologic and non-pharmacologic treatment. According to Mahajan, Godse & Bagadia (2018), the most important approach prior to starting the treatment of urticaria is to identify the etiology it. Then, once identified, it is important to encourage the patient to stay away from the causative agent. The appropriate pharmacologic treatment for acute urticaria in this 12-year-old boy includes antihistamine medication or localized antihistamine cream application (prednisone cream) to the affected skin to relieve urticaria. In contrast, according to Yadav & Bajaj (2014), the non-pharmacologic management of acute urticaria is to apply a soothing lotion after a tepid shower, apply cold wash clothes over the bump or itchy area, wear a loose and smooth cotton type of clothing, and avoid the sun (Yadav & Bajaj, 2014). In this case, it would be best to remove the 12- 12-year-old boy from the field to minimize further complications and assess the severity of the etiology of the diagnosis.
Godse & Varma (2018) identified multiple complications that can develop with urticaria, but the most important to avoid is infection. Our first line of defense to fight microorganisms is our skin, but once the skin breaks open, opportunistic pathogens or parasites will have the entryway to invade our body, causing complications such as infection. In this case, if the urticaria is left untreated, the 12-year-old boy will continue to itch, which will cause him to scratch the area with his fingers (maybe dirty) and destroy the integrity of the skin, allowing the bacteria to enter the body. If the bacteria that enters the open skin area of the 12-year-old boy are infectious microorganism, he will end up with cellulitis, which can lead to sepsis if not properly treated (Godse & Varma, 2018).
NR 507 Week 6 – Discussion Post
The most appropriate teaching to be given to the parent and the 12-year-old boy about urticaria is to avoid the triggers. Therefore, in this case scenario, if the cause of urticaria is stress from the soccer play, it would be best to avoid this activity. It might also be beneficial to take a preventative antihistamine medication before practice to prevent allergy flare-ups. As for the parent, it is important for the nurse practitioner to further educate about the proper home management of urticaria and what to avoid such self-medication, for example, administering steroids (unless otherwise prescribed by the nurse practitioner), which can lead to other complications. In addition, it is important to educate the parent about who and when to call if the symptoms worsen. As for the 12-year-old boy, it is important to educate him regarding handwashing before touching the affected area and not scratching the area to prevent infection. Also, it is important to educate the patient that it is important to tell his parents if he starts having difficulty breathing, as this is a sign of anaphylactic shock (Godse & Varma, 2018).
References
Godse, K., & Varma, S. (2018). Urticaria Control Test: A qualitative analysis for urticaria control. Urticaria, 24(3), 110–110. Doi: 10.5005/jp/books/13080_20
Hennino, A., Berard, F., Guillot, I., Saad, N., Rozieres, A. & Nicolas, J.F. (2014). Pathophysiology of urticaria. Clinical Reviews in Allergy & Immunology, 30(1), 3-11. DOI:10.1385/CRIAI:30:1:003
Mahajan, A., Godse, K., & Bagadia, A. (2018). Treatment of chronic urticaria. Urticaria, 13(3), 98–98. Doi: 10.5005/jp/books/13080_16
Tareen, K. N., & Tareen, R. S. (2016). Role of stress in urticaria syndrome. Stress and Skin Disorders, 34(6), 171–184. doi: 10.1007/978-3-319-46352-0_18
Yadav, S., & Bajaj, A. K. (2009). Management of difficult urticaria. Indian journal of dermatology, 54(3), 275–279. doi:10.4103/0019-5154.55641
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Question 
A 12-year-old boy is brought to the office for evaluation of hives. He has no significant past medical history and no history of allergies. He has just joined the middle school soccer team and noticed that he gets hives about 10 minutes into practice. The hives are itchy and consist of irregular blotches on his legs and trunk, about 10–20 cm in size, and they persist for about 30 minutes. He does not experience swelling of the lips or oropharynx and denies any wheezing or shortness of breath. His physical examination is normal, without skin lesions or oral swelling at that moment, and his lungs are clear. After evaluation, he was diagnosed with urticaria.
Discuss the likely cause of the patient’s urticaria.
Describe the cellular mechanism of urticaria and how it leads to the signs and symptoms experienced by the patient.
Describe the relationship between the patient’s symptoms and the concept of inflammation.
What pharmacological and non-pharmacologic treatment options are available?
Discuss the complications of urticaria.
What teaching would be appropriate to provide the parent and child about urticaria?
Support your response with at least one current evidence-based resource