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NURS 6501 Discussion: Alterations in Cellular Processes

Scenario:  A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Strep throat may be associated with recurrent infections caused by viruses and bacteria. In this scenario the patient is negative for recurrent infection and negative for virus but positive for bacteria with the strep throat result. It is a painful condition that can be life threatening if not treated. Children with multiple strep infections in a year may have a genetic trait that makes it hard to fight the infection. In this case the patient is negative because of no past medical history. Race and gender do not predispose an individual to this infection. Other factors of getting strep throat are common with children in the ages of 5-15 years and is less frequent with children under the age of 5 years. Streptococcus infection is the definite cause of strep throat, a group A streptococcus also known as pyogenes, is a bacterium responsible for this infection. If untreated can lead to recurrent episodes

NURS 6501 Discussion Alterations in Cellular Processes
NURS 6501 Discussion Alterations in Cellular Processes

, and more serious condition like rheumatic fever {McCance, & Huether.2019}. Strep pyogenes commonly spread from person to person, via the salivary glands through droplets or nasal discharge. Incubation period of 2-5 days, average 3days from time of exposure to develop symptoms, can last 3-7 days with and without treatment {CDC.gov, nd.}.

Genetically researchers discover that children with recurrent strep throat have smaller germinal centers in their tonsils which recognize and fight the bacteria. Strep infection causes the body to release small antimicrobial peptides. These short chains of amino acids are lethal to bacteria in several ways like poking a hole on the bacteria

NURS 6501 Discussion Alterations in Cellular Processes
NURS 6501 Discussion Alterations in Cellular Processes

membranes which activate reinforcements in the form of infection-fighting cells called neutrophil. Testing of throat culture to confirm diagnosis. Symptoms of fever, sore throat with painful swallowing with redness and white patches at the back of the throat and swelling of lymph nodes on the sides of the neck. Cold symptoms are excluded in strep throat infection. Treatment is with antibiotics, educate patient to avoid exposing others by frequent handwashing, cover mouth and nose when coughing and sneezing. Cleaning surroundings and changing of toothbrushes and avoid kissing others.  Clinically allergic disorder may accompany by airways inflammation like wheezing, an attack to the bronchial hyper-responsiveness, tachycardia, angioedema, tachypnea and hypotension.

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 There is a situation of anaphylaxis an allergic reaction. Hypersensitivity reaction are immune responses that are exaggerated or inappropriate against an antigen or collagen. They are classified in four forms. Type 1, 11, and 111 hypersensitivity reactions are known as immediate hypersensitivity reactions because it occurs within 24hours. The antibodies IgE, IgM, and IgG mediate them. Anaphylactic response is mediated by IgE antibodies that are produce by the immune system in response to environmental proteins also known as allergens such as dust, and mites {Vaillant & Zito, 2019}.

The process of this reaction is these antibodies IgE bind to mast cells and basophils that contain histamines granules that is released in reaction and causes inflammation. Type 1 or anaphylactic response is mostly seen in respiratory conditions like asthma, and allergic rhinitis, allergic dermatitis, food allergy, and anaphylactic shock. This allergic reaction can be distinguished as anaphylaxis, which is a medical emergency, that is acute and can lead to a life-threatening respiratory failure. It is the most severe form of an allergic reaction, falls under the category of an IgE-mediated process where mast cells suddenly release a large amount of histamine and later leukotrienes {Villant and Zito, 2019}. In the event of severe cases, there is a presentation of intense bronchospasm, cyanosis, laryngeal edema, hypotension, and shock. Drugs may cause allergic reactions by any mechanism of hypersensitivity. Drugs like penicillin may cause anaphylaxis, which is IgE-mediated but most responses can be trivial. Penicillin cross reacts with other semisynthetic penicillin including monobactams and carbapenems and may also cross react with other antibiotics such as cephalosporins. Immediate action is to call for emergency response.

NURS 6501 Discussion: Alterations in Cellular ProcessesEvaluation includes complete blood count to assess immunoglobulins, and detection of autoantibodies, total leukocyte and differential count, autoimmunity studies and a skin test can be done later for detection of allergies. Treatment and management of an IHR is best done with a multidisciplinary team that includes intensive care. Anaphylaxis management with intramuscular adrenaline, oxygen, intravenous antihistamine, and hydration of intravenous fluids to support the blood pressure, avoid latex products. Advance treatment can be tracheostomy in severe respiratory distress with laryngeal edema narrowing the airway. The prognosis of IHR depends on the severity and extension of tissue damage, available treatment and effectiveness in relation to the type of reaction such as disease, anaphylaxis, drug, plant or post transfusion. Educate patient about allergies and environment control.

Etiologically immediate hypersensitive reactions {IHR} have many causes depending on the type of antigen or allergen that trigger the inappropriate immune reactivity. In type 1 hypersensitivity reactions, the allergens are protein with molecular weight ranging from 10 to 40kDa. Animal, plants, fungi, dust mite, bee venoms, dairy, latex, shellfish and drugs including anesthetics can trigger anaphylaxis which stimulate the IgE production in the events of reactions.

Findings are hypersensitivity is common, and any type of allergic reaction will affect fifteen percent of the world population during their lifetime. There is an increase of allergic diseases, with unknown causes but can be attributed to lifestyle changes, low rate of breastfeeding and air pollution.

 Pathophysiology in type 1 hypersensitivity reactions after a previous sensitization, the immunoglobulin {Ig}E is produced and binds to Fc receptors on mast cells and basophils, and when it encounters the allergen, it causes a cross-linking of mast-cell cytophilic IgE, that activate mast cells and their degranulation of mediators that cause an allergic reaction. The mediators that participate in this type of hypersensitivity reaction include histamine and lipid mediators such as PAF, LTC4, and PGD2 that causes a vascular leak, bronchoconstriction, inflammation, and intestinal hypermotility. In this process tissue damage occurs by enzymes like tryptase and inflammation caused by TNF. Eosinophils releases cationic granule proteins that cause killings of the host cells and parasites, and enzymes like eosinophil peroxidase, which takes part in tissue remodeling. IgE initiates inflammatory and allergic reactions, a cell mediated and humoral immunity.

The immune system has three functions, which are to defend the body against invasion or infection by pathogens also known as antigens. It also removes dead or damage cells and attempts to recognize and remove abnormal cells {Khan Academy,2010}.

References

CDC.gov {nd.}. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Justiz-Vaillant, A. A., Zito, P. M. {2019}. Immediate hypersensitivity reactions. In Stat-Pearls. https://www.ncbi.nlm.nih.gov/books/NBK513315/

Khan Academy {2010}. Inflammatory response Human anatomy & physiology. Health and Medicine {video file}. https://www.youtube.com/watch

McCance, K. L. & Huether S. E. {2019}. Pathophysiology: The biologic basis for disease in adults and children{8th ed.}.

I enjoyed reading your discussion post this week and found it to be very informative. GAS infections, precursors of both invasive and immune-mediated disease sequelae, are present with 111 million prevalent cases of GAS in children and more than 600 million new cases of GAS pharyngitis per year ( Dasom & Soo, 2021). Sustained control of GAS infections in settings of poverty has proven to be challenging, and an effective vaccine may be the most practical long-term strategy to reduce the burden of GAS-related diseases such as rheumatic heart disease and post-streptococcal glomerulonephritis. Appropriate use of laboratory testing for GAS pharyngitis and prescription of antibiotics is imperative. Antibiotics cause adverse drug reactions and immune-mediated hypersensitivity reactions such as anaphylaxis (Blumenthal et al., 2018). Blumenthal et al. (2018) further note that while 5%-15% of patients in developed countries carry an allergy from the β-Lactam drugs class, it is rare for a medication such as Amoxicillin to cause an IgE-mediated anaphylactic response ( Campbell et al., 2018). The explanation you provided describing the release of mast cells, basophils, and histamine makes logical sense as to why the patient experienced angioedema, difficulty breathing, and wheezing.

References

Campbell, P. T., Frost, H., Smeesters, P. R., Kado, J., Good, M. F., Batzloff, M., Geard, N., McVernon, J., & Steer, A. (2018). Investigation of group A Streptococcus immune responses in an endemic setting, with a particular focus on J8. Vaccine36(50), 7618–7624. https://doi-org.ezp.waldenulibrary.org/10.1016/j.vaccine.2018.10.091

Dasom Wi, & Soo-Han Choi. (2021). Positive Rate of Tests for Group a Streptococcus and Viral Features in Children with Acute Pharyngitis. Children8(599), 599. https://doi-org.ezp.waldenulibrary.org/10.3390/children8070599

McCance, K. & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier.

Main Post Week 1

Class:

Case Study: Strep Throat in an Adolescent

 The case study describes a 16-year-old male who was exhibiting symptoms of step throat and given amoxicillin, ultimately discovering this individual was allergic to penicillin. The male had no known drug history and was treated with the common medication for this disease. Had the patient had this diagnosis previously, the allergy would have been discovered a while ago and avoided at this age. 

Genetics

 A group of immunologists at La Jolla Institute for Immunology (n.d) stated they believed recurrent strep throat has a genetic factor, and it was noted children had less B and Tfh cells to produce antibiotics to fight this particular disease. While this child has not had step throat before, he could be at risk of recurrent infections if he received a gene from his parents causing decreased immunity, as he does not have the proper antibodies to fight step throat. However, having the gene passed to him alone would not be the only cause of this disease. McCance and Huether (2019) discussed the occurrence genes interacting with their environment as a multifactorial trait, as the child must come into contact with the bacteria in order to uncover the gene (p.161). Other factors that may impact the increased incident of getting strep throat could be poor diet and poor hygiene. 

Symptoms Presented

         Strep throat symptoms can vary from patient to patient. Strep Throat (2016) reported symptoms of step throat could include white or yellow spots in the back of the mouth, fever, sore and red throat, and swollen lymph nodes on the neck. According to the case study, the child had a sore, red throat with white spots, as well as swollen lymph nodes (cervical adenopathy). The practitioner had assessed the signs and symptoms and ordered a strep test, which had come back positive. McCance & Huether (2019) discussed the various ways the body protects itself, such as with physical barriers in the respiratory tract, goblet cells trapping bacteria and moving it to be expelled by coughing or sneezing, and through the inflammation process (191). The inflammation process means the body increases blood flow to the infected or injured site (redness), which causes swelling due to more fluid in one area (swollen lymph nodes), the swelling then causes pain (sore throat), and purulent exudate (white spots on tonsils) from a build up of white blood cells attempted to fight the bacteria (McCance & Huether, 2019, p.210). At times, the body may also raise its temperature to fight bacteria, hence the low-grade fever which can be high in some patients. 

Response to Stimulus and Cells Involved

         Amoxicillin had been prescribed to the child, as is with common practice for strep throat treatment. However, the practitioners did not know the child was allergic to this medication since he had not needed to take it in the past. Instead of allowing the drug to do its job and fight the bacteria, the body became hypersensitive to it and caused swelling, difficulty breathing, and wheezing. Torres et al. (2016) stated the IgE immune mechanisms are involved in response to allergic reactions, and for some reason with penicillin, the patient can become allergic to all penicillin (cross-reactive) or the body can be selective. Multiple cells are involved with the process of allergic reactions, as inflammation has caused the bronchial tubes and airway to start to close, as well as lip and tongue swelling. The decreased airflow through the lungs caused the wheezing. According to Warrington (2012), some of the cells involved in this type of reaction are basophils and mast cells, which encourage the release of inflammatory mediators. The mediators can trigger activation of other cells. Per McCance & Huether (2019), additional cells involved are phagocytes, lymphocytes, endothelial cells, natural killer cells, and platelets (p.216). The body views the medication as an intruder and attacks the same way it would attack a bacteria or virus.

Other Characteristics

         Strep throat can occur in all genders and ages. However, it does not occur as often in adults (under 65), especially if they are not immune-compromised or work with children closely. If the patient had coughing, runny nose, I would not necessarily think it was strep as those are not regular symptoms. There is not much that would change my response unless the child was completed isolated from others, which one could assume a 16-year-old male would not be. I believe the reaction to provide the antibiotic was appropriate, as they could not predict the allergic reaction. The symptoms appeared to correlate with strep throat, and the test was positive. 

References

La Jolla Institute for Immunology (LJII). (n.d.) Strep throat. https://www.lji.org/diseases/strep-throat/

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children(8th ed.). St. Louis, MO: Mosby/Elsevier.

Strep Throat. (2016). American Family Physician, 94(1), 1. 

Torres, M. J., Montañez, M. I., Ariza, A., Salas, M., Fernandez, T. D., Barbero, N.,  Mayorga, C., & Blanca, M. (2016). The Role of IgE Recognition in Allergic Reactions to Amoxicillin and Clavulanic Acid. Clinical & Experimental Allergy, (46), 2, 264-274. doi: 10.1111/cea.12689.

Warrington, R. (2012). Drug Allergy. Human Vaccines and Immunotherapeutics, 8(10), 1513–1524. doi: 10.4161/hv.21889

, it is true that cells are the basic structural components of the body and are specialized to conduct different functions in the body. The central dogma also illustrates the pivotal role of genes in dictating the specialization of cells and subsequent events. Disease can alter the nature of cells thereby interfering with the normal cell functions. I find your case analysis quite intriguing, there are many patients who complain of sore throat that is related to allergic conditions and your analysis through genetic involvement is informative (Centers for Disease Control and Prevention,2021).

Group A streptococcus pharyngitis among children and adolescents is common and the identification of the genes associated with the common occurrence provides an avenue for solving the menace. Hypersensitivity relation to genetic composition also provides a better understanding of the recurrence of such cases (McCance & Huether, 2019). I also think that the bod defense system is triggered by recognition of the pathogen and the process of acting against the identified antigen leads to the symptoms, which include inflammation that would be felt as sore throat.

I agree hat the physiological processes upon identification of the antigen includes a variety of cells mediators that take part in the inflammatory pathway. These processes cause heat, swelling and redness. The patient characteristics that define different responses include age as age relates to immunity. Children are more susceptible to some diseases as compared to adults. Elderly people are also prone to some diseases that are not so common among young adults. Allergy to drugs also links to age as the allergy increases with age (Soderholm et al., 2018). I concur with you that severe allergic reaction would definitely be a concern

References

Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal

pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in

adults and children (8th ed.). Mosby/Elsevier.

Centers for Disease Control and Prevention. (2021, November 23). Pharyngitis (strep throat): Information for clinicians. Retrieved March 1, 2022, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html

Hello

It is true that cell environment stressors cause alterations within the cell and different diseases cause alterations as cells respond to change. Ultimately, the processes of reacting to change would be expressed as symptoms as evident in the child in the case study. Pharyngitis, caused by bacteria and treatable by administering Amoxicillin 500 mg would involve different processes and responses. Consideration of genetic and age factors become critical in analyzing the symptomatic expressions and the outcome upon administration of the medication (Mccance & Huether, 2018).

I believe that association of streptococcus Group A (SGA) bacteria with genetic variations at the HLA region define the susceptibility of children to SGA (Medline Plus, 2021). This is expressed through symptoms like sore throat as a result of inflammatory reactions that links to the immune cell interaction with the perceived pathogen.  Patients who have an alteration of the gene are not capable of producing g sufficient antibodies in response to the pathogen (Mccance & Huether, 2018). This leads to a recurrence and the need for medication. Inflammatory mediators triggered upon detection of pathogens may lead to redness, heat, swelling and pain.

Type-1 hypersensitive reaction involving immune cells such as the Helper-T cell results to the symptoms evident by the patient. Additionally, I agree that research indicate that there is a relation between age and susceptibility to disease. Some diseases are common among the elderly while some are common among children. It is true that pharyngitis is most common among children between age 5 and 15 (Mccance & Huether, 2018). Adults may also present with sore throat regardless of attaining remarkable immunity. Treatment require consideration of age in order to administer the correct doses and to prevent cases of adverse reactions.

References

Mccance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book: The biologic basis for

disease in adults and children (8th ed.). Mosby.

Medline Plus. (2021, February 22). What is a cell?: Medlineplus genetics. Retrieved March 1,

2022, from https://medlineplus.gov/genetics/understanding/basics/cell/

Alterations in Cellular Processes

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

by day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

  • The role genetics plays in the disease.
  • Why the patient is presenting with the specific symptoms described.
  • The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
  • The cells that are involved in this process.
  • How another characteristic (e.g., gender, genetics) would change your response.

Read a selection of your colleagues’ responses.

by day 6 of Week 1

Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your peers’ posting. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!