The adaptive response is an important aspect of adaptive immunity which is compensatory, and it is activated in the presence of an inflammatory process that is initiated by pathogens (Huether& McCance, 2012). The inflammation that triggers the onset of adaptive response occurs once the integrity of external barriers has been compromised (Huether& McCance, 2012). An advanced practice nurse is expected to poses the ability to use signs and symptoms associated with disease processes and correctly relate them with the conditions. This will ensure proper diagnosis of the condition is arrived at and therefore appropriate treatment is administered. Here, the pathophysiology associated with signs and symptoms resented in the three scenarios will be discussed in more details. Additionally, a mind map indicating various aspects of the disease process associated with stress response which includes epidemiology, risk factors, pathophysiology, clinical signs, and symptoms as well as diagnostic assessments will be presented.
Tonsillitis
In the first scenario, we are presented with a 2-year old female by the name Jennifer who is in the company of her mother who is concerned that her daughter is presenting with various symptoms which include: Inability to take her breakfast or sit still; a fever on and off for the last 3 days with a high temperature of 103.2° F on that day and being fussy. The mother noted that she was in good health prior to the three days. Physical examination on Jennifer revealed a hot and dry skin, her height and weight were appropriate for her age and gender, and tympanic membrane appeared normal but slightly reddened on the periphery. The examination also showed that her throat is erythematous with 4+ tonsils characterized with diffuse exudates, readily palpable anterior cervical nodes which are tender to touch on the left side and hurting throat that is characterized with pain when swallowing.
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In terms of vital signs, she exhibits the following; pulse rate-128 beats/minute, temperature-102.8° F, and respiratory rate- 24 beats/minute.
With these signs and symptoms, it is concluded that Jennifer was suffering from acute tonsillitis and as a result, the available treatment options for acute tonsillitis are considered.
In medical terms, acute tonsillitis refers to the inflammation of the pharyngeal tonsils and in often occurs together with pharynx inflammation in which case it is referred to as tonsillopharyngitis (Medscape, 2019). This condition, in particular, is more common in children and its primary causative agents are group A streptococci (GAS) and viruses which are the cause of most acute tonsillitis cases (Medscape, 2019). Normally, acute tonsillitis is self-limiting although confirmation of GAS as the causative agent initiation of antibiotic treatment preferably penicillin is necessary to avert post-streptococcal glomerulonephritis and rheumatic fever complications (Medscape, 2019). For bacterial tonsillitis, beta-hemolytic streptococcus pyogenes (GABHS) adheres onto the adhesion receptors of the epithelium of the tonsil (Medscape, 2019). The inflammation of the tonsils occurs as a result of the inflammatory response by the host immune against the organisms as the organisms invade the mucosa lining of the tonsils. Symptoms such as fever, erythema, exudates, and swelling of the lymph nodes are as a result of the body’s adaptive response to the condition. Apart from antibiotic therapy for bacterial tonsillitis, other treatment options include tonsillectomy in chronic tonsillitis, use of NSAIDs as fever and pain relievers, and adequate hydration accompanied with rest (Medscape, 2019). Complications associated with this condition are the occurrence of abscesses which may lead to breathing difficulty due to airways obstruction and sleep apnea.
Contact Dermatitis
In the second scenario (scenario 2), we are presented with Jack who is a twenty-seven-year-old male with the following symptoms: red, flaky hands in the last two weeks, feeling a little hot and denies any discomfort or pain. Given the nature of his job (maintenance engineer), he accepts handling abrasives in terms of solvents and chemicals. He admits that he recently worked without gloves due to what he termed as a shortage of gloves and as a result, it is concluded that he is suffering from contact dermatitis. Treatment options for the condition are then considered.
The most common type of contact dermatitis is irritant contact dermatitis(Johansen et al., 2015). It has the tendencies of occurring acutely and quickly when the skin which acts as a protective barrier is exposed to irritating or abrasive chemicals, heat or is rubbed too hard. During the exposure the skin barrier is broken and inflammation which is the adaptive body response takes place as damage to epidermal cells is caused (Johansen et al., 2015). The inflammatory response is the cause of observed redness, pain, swelling, and heat. At times this may lead to loss of function to the skin which is the affected organ.
In the case of irritant contact dermatitis, the adaptive responses commonly observed are increased vascular permeability to increase the influx of plasma proteins, leucocytes, and other mediators to the site of the injury and vasodilation (Johansen et al., 2015). Vasodilation increases blood flow into the affected site, and it is responsible for transporting the components mentioned earlier to the site of injury. The length, extent and the strength of the irritating chemical determine the severity of the damage due to irritant dermatitis (Johansen et al., 2015). According to Johansen et al. (2015), treatment of irritant contact dermatitis is initiated with avoiding the irritant, followed by topical medications (use of steroid cream, hypo-irritating lotions) and phototherapy which will help to calm and the inflammation.
Stress Response
In the third scenario (scenario 3) we are presented with a sixty-five old female by the name Martha and who presents with the following symptoms: anorexia, “racing heartbeat,” and insomnia. Martha’s medical history indicates that she has well-controlled hypertension using hydrochlorothiazide. The above symptoms and her medical history point to a diagnosis of the stress response. There are many causes of stress in life. Some of these causes are notable life changes such as exposure to trauma, abuse, losing a relative or loss of a job. (Huether& McCance, 2012).In the case of Martha, she had retired from her job where she worked as an administrative assistant and apparently she was stressed about it. According to Huether& McCance, (2012), the beginning of stress is marked by the presence of a stimulus that is perceived as stressful. In that case, the body has its mechanism that it uses to adapt to the presence of the stressful stimulus. This ensured through the promotion of survival-related physiological response. The body exhibits what Hans Seyle referred to as general adaptation syndrome which is a nonspecific response to noxious stimuli occurring in a triad manifestation. Biologically, the body responds to stress in three major steps which include reaction/alarm stage, resistance/adaptation stage and finally exhaustion stage (Huehter& McCance, 2012).
During stress response, the sympathetic nervous system is activated to release norepinephrine. Norepinephrine acts on the adrenal gland specifically the medulla which secrets and release catecholamines which find its way into the bloodstream (Huether& McCance, 2012). The catecholamines released interfere with the normal functioning of the cardiovascular system make it impossible to control Martha’s hypertension as it was before. Epinephrine which is one of the catecholamines released enhanced the contractility of the heart muscles which increased Martha’s heart rate and hence increased hypertension. In addition to adrenal medulla stimulation and release, the adrenal cortex secret and release glucocorticoids in response to stress. Huether& McCance (2012), stated that glucocorticoids have a major role in central nervous system homeostasis which is responsible for regulation of cognitive function, memory, sleep, and mood. This clearly explains the genesis of symptoms that Martha presented with. The recommended treatment and management options for Martha would be providing counseling services, encouraging her to join support groups that comprise of people in similar situation, and socialize more frequently as this will help her to relieve the stress.
Conclusion
In summary, the three scenarios and the Chapter 6 in the Huether and McCance text was reviewed, and the pathophysiology, patient’s adaptive responses as well as the associated alterations as a result of the disease processes were discussed and determined. As per my diagnosis, the determined conditions for each scenario were Tonsillitis, contact dermatitis, and stress response for scenarios one, two, and three respectively. The clinical signs and symptoms, epidemiology, pathophysiology, risk factors, adaptive responses, and diagnostic assessment associated with stress response were presented in the form of a mind map. For the advanced practice nurse, ability to understand and use the pathophysiology and the adaptive body responses to diagnose and appropriately and accurately treat the patients is very critical to the provision of quality healthcare.
References
Johansen, J. D., Aalto ‐ Korte, K., Agner, T., Andersen, K. E., Bircher, A., Bruze, M., ... & John, S. M. (2015). European Society of Contact Dermatitis guideline for diagnostic patch testing–recommendations on best practice. Contact dermatitis, 73(4), 195-221.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
Medscape. (2019). Tonsillitis and Peritonsillar Abscess: Practice Essentials, Background, Pathophysiology, and Etiology. (2019). Emedicine.medscape.com. Retrieved 2nd March
McGuckin, M., &Govednik, J. (2017). Irritant contact dermatitis on hands: literature review and clinical application. American Journal of Medical Quality, 32(1), 93-99.
