NURS 6501 Week 2 Assignment: Adaptive Response

NURS 6501 Week 2 Assignment: Adaptive Response

NURS 6501 Week 2 Assignment: Adaptive Response

 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.

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. 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.

Sample Scenario One Solution: Tonsillitis

The scenario portrays a two-year-old female patient who presents fussiness, hot and dry skin, anorexia and tympanic membrane which is slightly reddened on the periphery. The patient further depicts erythematous throat with diffuse exudate and four plus tonsils. Additionally, the mother states that her temperature ranges from 102.8 degrees to 103.2 degrees. The patient is complaining of throat pain when swallowing. However, the judgment of tonsillitis will base on the clinical results Adaptive Response Sample Essay Assignment paper.

Tonsillitis is a contagion whereby the tonsils irritate (Yamashita et al., 2016). For this infection, the adaptive responses involve a sore throat, pain when swallowing, swollen tonsils, exudate, fever, tender lymph nodes at the neck, headache, stiff neck, lousy breadth as well as a stomachache. Tonsillitis belongs to secondary group A beta-hemolytic Streptococcus (GABHS) and the rising MRSA. McCarthy argues that tonsillitis often affects children from preschool ages to mid-teenage years (2014). According to Chiappini et al. the macrophages which are present in the tonsils engulfs the infected organisms which eventually secretes digestive enzymes that starts to destroy the body (2015) Adaptive Response Sample Essay Assignment paper. Research has revealed that if tonsillitis is not treated, it may result in a condition known as post-streptococcal glomerulonephritis or sometimes rheumatic fever. Adaptive Response Sample Essay Assignment paper. 

Adaptive Response Case Study #1 Sample Solution 2

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.

Scenario #1 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.

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.

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.

Sample Scenario Two Solution: Allergic Contact Dermatitis

The second scenario describes a twenty-seven-year-old male patient presented with redness and hands imitation after being exposed to harsh solvents and chemicals. The patient claims that his hand is feeling quite hot, but he does not feel any pain. The clinical findings determine the diagnosis of the allergic contact dermatitis. Popple et al. mention that the adaptive response of allergic contact dermatitis involves the edema, pruritus and the erythema (2016) Adaptive Response Sample Essay Assignment paper.

The allergic contact dermatitis is an infection which is caused a specified immune-mediated reaction of the body to a substance which has touched the skin. The patient’s conditions are attributed to his frequent contact with chemicals while working. Some of the elements which cause allergy include dyes, preservatives, and fragrances among other chemicals. The edema in the epidermis sources the separation of the keratinocytes. Popple et al. stipulate that a sensitizing antigen forms when the allergen bounds to a carrier protein and also when the allergen comes in contact with the skin (2016). The Langerhans cells in the skin exhibit the antigen and eventually takes the antigen to the T cells. Consequently, the T cells are prepared which in turn initiates the releasing of the provocative cytokines as well as the indicators of redness. Pruritus and swelling eventually follow thus depicting allergic contact dermatitis. The patient does not use gloves. Therefore he is exposing his hands to dangerous chemicals. It is essential to carry out allergy and patch testing to recognize the allergen so that it can be prevented on time. Allergic contact dermatitis is treated using the topical corticosteroid Adaptive Response Sample Essay Assignment paper.

Adaptive Response Case Study #2 Sample Solution 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.

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.

Sample Scenario Three Solution: Depression

The third scenario depicts a sixty-five-year-old woman presented with topical loss of appetite, racing heartbeat, insomnia, and sleep disturbances. There are critical changes in the woman’s life including the care of her eighty-seven-year-old ailing mother. According to the research, the pathophysiology of depression is not understood. The clinical findings will depict the diagnosis of depression for the patient. A disruption of central nervous system activities is indicated based on the clinical trials Adaptive Response Sample Essay Assignment paper.

Finsterwald and Alberini explain the adaptive responses of depression which includes the loss of appetite, increased heart rate and sleep disturbances (2014). The scholars’ further mention that depression is triggered by a mixture of physical, genetic and biological elements (pg. 18). Many diverse aspects which can source depression comprise of the change in life, drug and substance abuse, alcohol, and trauma Adaptive Response Sample Essay Assignment paper. Depression may sometimes lead to suicide and disruption of social relationships. The treatment of depression depends on the sternness of depression. According to Halverson, the nurse or the physician can prescribe to the patient antidepressant such as Tricyclic antidepressants or selective serotonin reuptake inhibitor (SSRI) (2016) Adaptive Response Sample Essay Assignment paper.

Adaptive Response Case Study #3 Sample Solution 2

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.

References

Chiappini, N., Cantisani, R., Pancotto, L., Ruggiero, P., Rosa, D., Manetti, A., … & Del Giudice, G. (2015). Innate response activator (IRA) B cells reside in human tonsils and internalize bacteria in vitro. PloS one, 10(6), e0129879.

Finsterwald, C., & Alberini, C. M. (2014). Stress and glucocorticoid receptor-dependent mechanisms in long-term memory: from adaptive responses to psychopathologies. Neurobiology of learning and memory, 112, 17-29 Adaptive Response Sample Essay Assignment paper.

McCARTHY, J. P., Agre, J. C., Graf, B. K., Pozniak, M. A., & Vailas, A. C. (2014). Compatibility of adaptive responses with combining strength and endurance training. Medicine and science in sports and exercise, 27(3), 429-436.

Popple, A., Williams, J., Maxwell, G., Gellatly, N., Dearman, R. J., & Kimber, I. (2016). The lymphocyte transformation test in allergic contact dermatitis: New opportunities. Journal of immunotoxicology, 13(1), 84-91. Adaptive Response Sample Essay Assignment paper.

Yamashita, K., Ichimiya, S., Kamakura, R., Nagata, T., Jitsukawa, S., Matsumiya, H., … & Himi, T. (2016). Studies of Tonsils in Basic and Clinical Perspectives: From the Past to the Future. In Excellence in Otolaryngology (Vol. 77, pp. 119-124). Karger Publishers.

Halverson, J. L. (2016, April 29). Depression. Retrieved from Medscape: http://emedicine.medscape.com/article/286759-overview#a3 Adaptive Response Sample Essay Assignment paper.

NURS 6501 Week 2 Assignment: Adaptive Response Instructions

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.

· 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.

                                                        Learning Resources

Required Readings

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

• Chapter 6, “Innate Immunity:      Inflammation and Wound Healing”

This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound healing process.

• Chapter 7, “Adaptive      Immunity”

This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.

• Chapter 8, “Infection and      Defects in Mechanism of Defense”

This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder—HIV/AIDS.

• Chapter 9, “Stress and      Disease”

This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.

• Chapter 10, “Biology of      Cancer”

This chapter explores the developmental process of cancer and factors that impact the onset of cancer at the cellular level. It also describes various treatment options.

• Chapter 11, “Cancer      Epidemiology”

This chapter reviews genetic, environmental, behavioral, and diet-related risk factors for cancer. It also examines types of cancers that result from risk factors.

• Chapter 12, “Cancer in      Children and Adolescents”

This chapter focuses on the presentation and prognosis of childhood cancers. It examines the impact of genetic and environmental factors on these cancers.

• Chapter 38, “Structure and      Function of the Musculoskeletal System”

This chapter covers the structure and function of bones, joints, and skeletal muscle. It also explores effects of aging on the musculoskeletal system.

• Chapter 39, “Alterations of      Musculoskeletal Function”

This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of bone, joints, and skeletal muscle disorders. Additionally, it explores musculoskeletal tumors, osteoarthritis, and rheumatoid arthritis.

• Chapter 40, “Alterations of      Musculoskeletal Function in Children”

This chapter includes musculoskeletal disorders that affect children, such as congenital defects, bone infection, juvenile idiopathic arthritis, muscular dystrophy, musculoskeletal tumors, and nonaccidental trauma.

• Chapter 41, “Structure,      Function, and Disorders of the Integument”

This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.

• Chapter 42, “Alterations of      Integument in Children”

This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.

Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

• Chapter 3, “Disorders of the      Immune System”

This chapter explores the anatomy and physiology of the immune system. It also explores the pathophysiology of various immune disorders such as primary immunodeficiency diseases and AIDS.

• Chapter 8, “Diseases of the      Skin”

This chapter begins with an overview of the anatomy and physiology of skin. It also explores the pathophysiology of various types of skin lesions and inflammatory skin diseases.

• Chapter 24, “Inflammatory      Rheumatic Disease”

This chapter explores the pathogenesis of inflammation and its role in rheumatic diseases. It also examines the clinical presentation, etiology, pathophysiology, and clinical manifestations of rheumatic diseases such as gout and rheumatoid arthritis.

Required Media

Zimbron, J.  (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://www.medmaps.co.uk/beta/

Gastro-oesophageal reflux disease. [Image]. Used with permission of MedMaps.

This media provides examples of mind maps for dementia, endocarditis, and gastro-oesophageal reflux disease (GERD).

Optional Resources

Arthritis Foundation. (2012). Retrieved from http://www.arthritis.org/ 

Lupus Foundation of America. (2012). Retrieved from http://www.lupus.org/newsite/index.html

NURS 6501 Week 2 Assignment: Adaptive Response RUBRIC

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS 6501 Week 2 Assignment: Adaptive Response

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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