Nsg 5003 – Wk 2 Response to Discussion Post:
Assignment:
I already submitted my initial post regarding Anna Sanchez and her condition. I need help with the responses to other students. Here is the assignment I need help with (please respond to all)
• Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented.
• Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers (i.e., rhinitis or sinusitis).
• Identify what diagnostic testing or additional information you might need to establish a diagnosis.
FYI, Here is a portion of a discussion post to respond to:
Clinical manifestations of an acute infection vary depending on the pathogen. Initial symptoms include aches, pains, fever, malaise, nausea, fatigue, loss of appetite. Fever is the hallmark of most infectious diseases (McCance & Huether, 2018). In our case study, there is no evidence that Anna has an acute severe infection. She reports her symptoms have been present for 5 weeks, which is much longer than the typical course of an acute infection. Additionally, she does not report any other symptoms that are typically associated with acute infections, such as fever, body aches, or extreme fatigue. Finally, she reports getting frequent “colds” every spring and fall, which is another indication that she does not have an acute infection.
If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
Hypersensitivity is a change in the immune system’s reaction to an antigen that causes disease or harm to the patient. Allergic rhinitis (AR) is a symptomatic nasal condition caused by Type I IgE-mediated hypersensitivity reactions to allergens, and it is defined by four cardinal symptoms: watery rhinorrhea, nasal obstruction, nasal itching, and sneezing (Min, 2010). As a result of antigen exposure, type I hypersensitivity develops. The antigen response is divided into two stages: sensitization and effect. The host falls under asymptomatic contact with the antigen during the sensitization stage. The pre-sensitized host is subsequently re-introduced to the antigen during the “effect” phase, resulting in type I anaphylactic or atopic immunological response (Abbas, Moussa, & Akel, 2021).
A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
Sensitization to a specific antigen is required for hypersensitivity reactions, which result in primary and secondary immunological responses. When an individual has enough antibodies or T cells to cause a detectable reaction when exposed to the antigen again, they are sensitized. Some people are sensitized very quickly (after a single apparent antigen exposure), whereas others require several exposures over months or years. Hypersensitivity reactions can be immediate or delayed after sensitization, depending on the duration between re-exposure to the antigen and the start of clinical symptoms. Immediate hypersensitivity reactions are those that happen within minutes to a few hours. A delayed hypersensitivity response might take many hours to develop and peak several days after re-exposure to the antigen
Sample Paper
Wk 2 Response
Thank you for your post. In relation to the patient’s reports of getting frequent “colds” every spring and fall, following a comprehensive history and physical assessment, it can be ruled out that she has Allergic Rhinitis (AR). Usually, AR causes cold-like symptoms, i.e., itching, sneezing, and a runny or blocked nose (Ma, Lu & Mai, 2021). These symptoms commonly begin soon after being exposed to an allergen. Correspondingly, allergic rhinitis can cause falls as a result of Vertigo. Vertigo is an unusual but severe allergy symptom most common in AR sufferers.
A significant differential diagnosis for AR is Vasomotor Rhinitis (VR). Vasomotor rhinitis is a term often applied to describe the symptoms of rhinitis associated with non-allergic, noninfectious causes without a clear aetiology after the conclusion of a comprehensive search for a diagnosis. According to Leader & Geiger (2021), the pathophysiology of VR is complex, with still much requiring to be discovered. It’s partly due to an imbalance between the sympathetic and parasympathetic inputs on the nasal mucosa. The clinical presentation of VR involves persistent or sporadic nasal symptoms caused by cold air, strong smells, changes in the temperature, barometric pressure, strong emotions, humidity, alcohol and variations in hormone levels. It similarly presents with fall issues related to Vertigo.
Diagnostic testing may include a skin prick test (Traiyan et al., 2021). With this test, an allergen is positioned on an individual’s arm and skin’s surface pricked with a needle to present allergen to an individual’s immune system. In case one is allergic to substances, a small itchy spot appears. Similarly, a nasal endoscopy can be completed where a thin tube with a light source and a video camera at one particular end is inserted in the nose to check in the nose. Besides, a nasal inspiratory flow test can be done where a small device is engaged over the nose and mouth to determine airflow when inhaling through the nose.
References
Leader, P., & Geiger, Z. (2021). Vasomotor rhinitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547704/
Ma, Y., Lu, L., & Mai, Q. (2021). Clinical Diagnosis and Treatment Characteristics of Acute Respiratory Infections in Children and New Developments in Laboratory Testing. Open Journal of Pediatrics, 11(1), 114-124. DOI: 10.4236/ojped.2021.111011
Traiyan, S., Manuyakorn, W., Kanchongkittiphon, W., Sasisakulporn, C., Jotikasthira, W., Kiewngam, P., & Benjaponpitak, S. (2021). Skin prick test versus phadiatop as a tool for diagnosing allergic rhinitis in children. American Journal of Rhinology & Allergy, 35(1), 98-106. https://doi.org/10.1177/1945892420938300
