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NR 507 Week 7 – Disease Process Presentation – PART 3

NR 507 Week 7 – Disease Process Presentation – PART 3

Identify the correct hypersensitivity reaction:

The likely diagnosis of this patient would be allergic rhinitis (AR); however, there are methods, diagnostic procedures, and tools used to determine a clear diagnosis for this patient, such as screening the patient’s medical and family history and collection of genetic factors and environmental factors. The patient may obtain a skin prick test, patch test, or intradermal test through an allergist to determine their sensitivities (American College of Allergy, Asthma, and Immunology, 2020).

Explain the pathophysiology associated with the chosen hypersensitivity reaction:

Allergic rhinitis, also known as hay fever, includes symptoms that affect the nose. It occurs when the body recognizes something in the environment and overreacts. This hypersensitivity is considered an immune response. There are four types of hypersensitivity reactions: type I (IgE-mediated reactions), type II (tissue-specific reactions), type III (immune complex–mediated reactions), and type IV (cell-mediated reactions). Many allergic reactions, like allergic rhinitis, are considered type I (IgE-mediated reactions). The first exposure to an allergen causes a presentation of the antigen-presenting cell to B lymphocytes, which are considered the followers of T-cells (Th2 cells). These Th2 cells produce cytokines that assist in the maturation of the B lymphocytes into plasma cells that secrete IgE. The IgE is absorbed to the surface of the mast cell by binding to specific IgE Fc receptors.

When there is a significant amount of IgE bound to the mast cell, it then becomes sensitized. When an individual is re-exposed to the allergen, the allergen ultimately cross-links the IgE that’s bound to the mast cell and causes degranulation of the mast cell. The mast cell then induces a reaction that causes histamine in the body to react, inducing local edema, mucous secretion, smooth muscle contraction, and other acute inflammatory responses (McCance, K. L., & Huether, S. E., 2019). Regarding the case study, the 35-year-old woman presented with nasal congestion and recurrent sinus infections. She noticed a great improvement when she went on a two-week Caribbean cruise when she was no longer exposed to the allergen, the cat who joined the family one year ago, the same timeframe when her symptoms began.

NR 507 Week 7 – Disease Process Presentation – PART 3

Identify at least three subjective findings from the case:

In the case study presented, the patient stated that she was experiencing the following symptoms: sneezing, recurrent sinus infections, and nasal stuffiness that “seems to never go away.”

Identify at least three objective findings from the case:

If the patient were to visit the primary care office for an examination, objective findings for the patient who is experiencing allergic rhinitis present with rhinorrhea, bluish or pale swelling of the nasal mucosa, ocular issues like swollen conjunctivae and watery discharge (American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2015).

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:

The first strongly recommended medication class for the treatment of allergic rhinitis is intranasal steroids (INS) for those diagnosed with AR corticosteroids. Examples of intranasal steroids include Fluticasone propionate (Flonase) and Budesonide (Rhinocort propellant AQ). The second strongly recommended medication class for the treatment of AR would be second-generation H1-receptor antagonists, which are oral antihistamines. Examples of H1-receptor antagonists include Cetirizine (Zyrtec) and Fexofenadine (Allegra) (Seidman et al.2015).

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

The mechanism of action for intranasal steroids was discovered through nasal allergen challenge models, which determined the significance of the reduction in a mediator and cytokine release with a decrease in nasal secretions through fewer basophils, eosinophils, neutrophils, and mononuclear cells. Overall, the reduction of the presence of these cells leads to a decrease in inflammatory cells and cytokines in the nasal mucosa. Intranasal steroids also inhibit the antigen-induced hyperresponsiveness of the nasal mucosa from reacting to the allergen. The onset of action for INS begins 3-5 hours to 36 hours after the first dose (Seidman et al.2015).

The mechanism of action for oral antihistamines includes a rapid onset of action causing the block of histamine toward the H1-receptor. Histamine lowers a high level of vascular permeability, which can lead to fluid traveling to areas of the body in surrounding tissues, which ultimately leads to swelling and the dilation of vessels. Antihistamines prevent this from occurring by becoming antagonists against the H1 receptors. There are first- or second-generation agents. The first-generation are lipophilic and can cross the blood-brain barrier. However, the second generation has limits to entering the central nervous system. The first-generation agents bind to the central and peripheral histamine-1 receptors, and the second-generation agents bind to peripheral H-1 receptors, which leads to differences in therapeutic actions and side effects. The duration of second-generation antihistamines works for 12-24 hours (Farzam, K., Sabir, S., & O’Rourke, M., 2020).

NR 507 Week 7 – Disease Process Presentation – PART 3

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

One treatment option that the panel recommended would be clinicians routinely performing sinonasal imaging on patients who present with symptoms that are common with the diagnosis of allergic rhinitis. The second treatment option that the panel recommended would be clinicians’ oral leukotriene receptor antagonists as the main therapy for those diagnosed with allergic rhinitis. However, as stated at the beginning of the case study, the collection of patient history, physical examination, and allergy testing are the main choices for determining the diagnosis of AR (Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., … Nnacheta, L. C. (2015).

Reference:

American Academy of Otolaryngology – Head and Neck Surgery Foundation. (2015). Clinical Practice Guidelines. Retrieved from

https://www.entnet.org/sites/default/files/uploads/PracticeManagement/Resources/_files/a llergic-rhinitis-history-and-physical-findings.pdf

American College of Allergy, Asthma, and Immunology. (2020). Hay Fever (Rhinitis) | Symptoms & Treatment. Retrieved from https://acaai.org/allergies/types/hay-feverrhinitis

Farzam, K., Sabir, S., & O’Rourke, M. (2020). Antihistamines. National Center for Biotechnology Information, 1(1), 1. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538188/

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., … Nnacheta, L. C. (2015). Clinical Practice Guideline. Otolaryngology–Head and Neck Surgery, 152(1), S1–S43. https://doi.org/10.1177/0194599814561600

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Question 


Introduce the disease with a brief definition and description.
Discuss the Risk Factors and the connection to the etiology of the initial injury to the
cell/tissue/organ.
Discuss health care provider implications for the prevention of the disease.
Show the progression from the initial injury to the defect in the tissue, organ, and system functioning.
Link changes in the tissue, organ, and system functioning to the initial presenting signs and symptoms seen in primary care of the disease.
Provide a brief description of how the disease is diagnosed.
Provide a brief description of the pharmacological and non-pharmacological interventions used to treat and manage the disease.
Summarizes the disease on the final slide with concluding remarks; includes implications for nurse practitioner practice.
Utilizes at least two current (within 5 years) peer-reviewed scholarly sources to support presentation content.
Reference slides and in-text citations depict references correctly cited according to APA.

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