Adaptive Response
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scenarios.docxRunning head: ADAPTIVE RESPONSE 2
ADAPTIVE RESPONSE 2
Adaptive Response
Walden University
NURS 6501-N – Advanced Pathophysiology
Basil G. Silao
June 11, 2018
Adaptive Response
Adaptation may be defined as a “reversible, structural, or functional response both to normal or physiologic conditions and to adverse or pathologic conditions” (Huether & McCance, 2017, p. 73). The purpose of this paper is to discuss three scenarios and to explain the pathophysiology, associated alterations, and the patients’ adaptive response to the alterations cause by the disease process. A presentation of mind map explaining a disease process is also included in this paper.
Scenario 1
The 2-year old female patient is the first scenario presented with a persistent temperature of 102.8 for the past 3 days. Her symptoms include erythema, 4+ tonsils with diffuse exudates, swollen and tender cervical lymph nodes, and painful swallowing. The patient’s age together with her symptoms is congruent with the criteria for diagnosing bacterial tonsillitis. Viral tonsillitis is different from bacterial tonsillitis. Symptoms in viral tonsillitis include pain, fever, cough, hoarseness, and rhinorrhea, while symptoms in bacterial tonsillitis include pain, lymph node swelling, tonsillar deposits or exudates, and fever above 38.3C (Stetler, 2014). The common causative organism of tonsillitis includes group A beta-hemolytic Streptococcus and methicillin-resistant Staphylococcus aureus (Huether & McCance, 2017). The disease process starts with the invasion of the mucous membrane by microorganisms. This event will trigger cytokine production and/or complement activation, which induce an inflammatory reaction in the tonsillar tissue (Huether & McCance, 2017).
Treatment includes steroids, non-steroidal anti-inflammatory drugs, beta-lactam antibiotics, and tonsillectomy if severe, and supportive therapy (Stetler, 2014). It is important to immediately identify and treat disease because the progression of it can cause upper airway obstruction, which is fatal to pediatric patients (Huether & McCance, 2017). A mind map further explains the epidemiology, pathophysiology, risk factors, and complications in Appendix B of this paper.
Scenario 2
In this scenario (see Appendix A), the patient presents with a chief complaint of red and flaky hands. He denies pain but verbalized that his hands feel “a little bit hot”. The patient’s occupation involves handling abrasive solvents and chemicals. Initially, the patient denies any exposure to irritants but later admits that his hands got exposed to some cleaning fluids. Although the patient claims that he always washes his hands after being exposed, this could still cause irritation to the skin. The patient’s diagnosis is consistent with irritant contact dermatitis (ICD). ICD is a non-specific inflammatory dermatitis caused by chemical irritation from different agents used in industry (Huether & McCance, 2017). It involves the activation of the innate immune system by the pro-inflammatory properties of chemicals which causes damage to the cutaneous integrity with epidermal lesions of different degrees of severity (Nosbaum et al., 2009).
In the third scenario, a 65-year old female with a history of hypertension presents with chief complaints of insomnia, loss of appetite, and intermittent palpitations. The patient admits that she just retired from work and that she has a recent role change at home as she recently is the main primary caregiver for her disabled mother. The patient’s symptoms together with a recent new change in her function at home is consistent with stress response. A stress response may be triggered by physical, physiologic, or psychologic/emotional factors (Huether & McCance, 2017). In this scenario, the patient may have physical stressor due to increased demand in her body to take care her dependent mother and may have psychological stressor due to perceived helplessness in her role change. This will in turn translate to physiologic responses such as increased heart rate and dry mouth (Huether & McCance, 2017). This explains the patient’s loss of appetite, increase heart rate and palpitation. Insomnia can also be caused by psychological and physiological stressors (Basta et al., 2007).
Conclusion
The cases discussed depicts a picture of how the body responds to change and how the body attempts to maintain its previous normal state. It is important to understand different factors such as age, occupation, and recent life events, as these may be huge factors in the disease process as well. Understanding the etiology, pathophysiology, and complications of the disease will guide a practitioner on his or her plan of care for the patient.
References
Basta, M., Chrousos, G. P., Vela-Bueno, A., & Vgontzas, A. N. (2007). Chronic insomnia and stress system. Sleep Medicine Clinics, 2(2), 279–291. Retrieved from http://doi.org/10.1016/j.jsmc.2007.04.002
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby
Nosbaum, A., Vocanson, M., Rozieres, A., Hennino, A., & Nicolas, J. F. (2009). Allergic and irritant contact dermatitis. European journal of dermatology: EJD 19(4), 325-332. doi: 10.1684/ejd.2009.0686 ·
Stelter, K. (2014). Tonsillitis and sore throat in children. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 13(7), 1-24. Retrieved from http://doi.org/10.3205/cto000110
Appendix A
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.
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.
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.
Appendix B
MIND MAP
Tonsillitis
Risk Factors
Epidemiology
Etiology
Age: 5-15years old Rhinovirus 30% of the cases are
Weak immune system Coronavirus bacterial tonsillitis
Exposure to microorganism Adenovirus More common in children
Contact with infected people Group A beta-hemolytic Prevalence rate of 15-30% to
streptococci (GABHS) children and 5-15% with Methicillin-resistant adults Staphylococcus aureus (MRSA)
Pathophysiology
Infiltration of microorganisms int the throat
Activation of cytokines and complement system
Inflammatory response
Management
Complications
Clinical Manifestations
Supportive care Sore throat Middle ear infection
Antibiotics Fever Peritonsillar abscess
Pain medication Pain when swallowing Obstructive sleep apnea
Surgery Tonsillar erythema Scarlet fever
Tonsillar enlargement Glomerulonephritis
Complete airway obstruction leading to hypoxia and death
Sources: Huether & McCain, 2017, https://online.epocrates.com/diseases/59833/Tonsillitis/History-Exam
