NURS 6501 Module 1 Assignment: Case Study Analysis
NURS 6501 Module 1 Assignment: Case Study Analysis
Background
Invasive Aspergillosis is a leading cause of death among patients with chronic and immune-suppressing diseases like rheumatoid. The disease is mainly caused by the opportunistic mold Aspergillus fumigatus, which is majorly pathogenic and airborne (Challa, 2018). Once inhaled, the pathogens are deposited in the alveolar and bronchioles of the lungs. The infection spreads more rapidly from the lungs to other organs like the brain, kidney, and heart, causing further infection. Delayed diagnosis of the disease impairs its successful treatment. Diagnosis of the disease is based on histological and cultural examination of the spores in tissues. Other methods of diagnosis like detection of components of Aspergillus like galactomannan (GM), DNA, and 1,3- β-D-glucan are being pursued to enable timely diagnosis of the disease for proper management. The purpose of this paper is to present
NURS 6501 Module 1 Assignment Case Study Analysis
an effective disease analysis of Aspergillosis as presented by the 49-year old patient and determine factors that may affect the progression of the disease in the patient.
Symptoms
In cases of neutropenia and immune suppression, the immune system is compromised, hence the body lacks
NURS 6501 Module 1 Assignment Case Study Analysis
defense, predisposing patients to opportunistic pathogens. Symptoms of Aspergillosis in patients include fever, coughing, dyspnea, pleuric chest pains, and hemoptysis in severe cases. Other symptoms of the disease may occur if the disease spreads to other organs. Rapidly progressive hypoxemia can also occur in severe diseases. Risk factors for developing Aspergillosis include bone marrow transfers, occurring either at the initial stages of prolonged neutropenia before engraftment or after graft following administration of corticosteroids in the management of graft-host adverse reactions.
Diagnosis
Diagnosis of the disease is based on demonstration of the mold spores on tissues after Gomori methenamine silver staining (GMS). Affected tissues have numerous spores and hyphae characteristic of aspergillus mold. Positive cultures obtained from sputum, needle biopsy, and bronchoalveolar fluid can be used as diagnostic tests (Jenks & Hoenigl, 2020). Clinical signs of the disease like fever and chest pains associated with coughing are used to classify the disease.
Genes that May Be Associated with the Development of Invasive Aspergillosis
Susceptibility markers for Invasive Aspergillosis are mainly found in the genes and are widely used in signaling the activation of nuclear factor-kappa B (NFκB). Current studies show that a growing number of well-defined simple nucleotide polymorphisms in genes determine the susceptibility of patients to Aspergillosis. Genes encoding for cytokines or chemokines and their respective receptors, single nucleotide polymorphisms (SNPs) in toll-like receptor genes, and other genes of inmate immunity like C-type lectins have been associated with the disease. The cells act as pathogen recognition receptors, leading to activation of the NFkB pathway, and can increase the risk of contracting the disease. In high-risk populations, the presence of the common genetic polymorphisms found in NFκB1, NFκB2, RelA, RelB, Rel, and IRF4 genes increase the susceptibility of the disease ( Lupiañez et al., 2016).
The Process of Immunosuppression and the Effect it has on Body Systems
Immunosuppression refers to the process of weakening the activity of the immune system. Induced immunosuppression is the process of deliberately reducing the activity of the immune system by administration of drugs such as azathioprine, corticosteroids, and cyclosporine to patients mainly following graft transplant to reduce graft rejection by the host. In some disease processes like Glioma, Glioma cells start the immunosuppressive network that impairs the activity of the effector cell and decreases the efficiency of any therapeutic measures to restore normal immunity (Mangani et al., 2017). Immunosuppression can also occur following an adverse reaction in disease treatment. The whole process reduces the efficiency of the immune system in fighting diseases, making the patient more susceptible to infections.
References
Challa, S. (2018). Pathogenesis and pathology of invasive aspergillosis. Current Fungal Infection Reports, 12(1), 23-32. https://link.springer.com/article/10.1007/s12281-018-0310-4
Jenks, J. D., & Hoenigl, M. (2020). Point-of-care diagnostics for invasive aspergillosis: Nearing the finish line. Expert Review of Molecular Diagnostics, 20(10), 1009-1017. https://doi.org/10.1111/myc.12881
Lupiañez, C. B., Villaescusa, M. T., Carvalho, A., Springer, J., Lackner, M., Sánchez-Maldonado, J. M., … & PCRAGA Study Group. (2016). Common genetic polymorphisms within NFκB-related genes and the risk of developing invasive aspergillosis. Frontiers in microbiology, 7, 1243. https://doi.org/10.3389/fmicb.2016.01243
Mangani, D., Weller, M., & Roth, P. (2017). The network of immunosuppressive pathways in glioblastoma. Biochemical pharmacology, 130, 1-9. https://doi.org/10.1016/j.bcp.2016.12.011
One of the most useful components of patient care is a correct diagnosis which leads to offering a patient the correct treatment. Central to correct diagnosis and treatment is an understanding of the cell, and cell behavior as come conditions may have various circumstances and factors affecting their onset, hence making them more complex (Karaca & Aslan, 2018). Therefore, understanding the cells and cell behavior needs to be integrated with ethnic and racial variables, patient characteristics, environment, and genes. This week’s assignment deals with a patient cases study where the symptoms presented by the patient will be analyzed using various discussion questions.
Why the Patient Presented With the Symptoms
The patient has presented with various symptoms such as fevers, constipation, and crampy left lower quadrant pain. After refusing colonoscopy for some time, the patient eventually went for one, which revealed a positive test for adenocarcinoma of the colon. Even though the patient went for colonoscopy after resolution of the acute diverticulitis, the symptoms presented at the clinic point to a recurring case of acute diverticulitis. The patient has the three most common symptoms of diverticulitis (fever, constipation, and pain in the lower left quadrant). The condition is more an individual’s lifetime and therefore could be troubling the patient. The patient also eats a diet lacking in fiber and is obese, which are all factors leading to the development of the condition.
Genes That May Be Associated With the Development of the Condition
According to Strate & Morris (2019), diverticulitis may result from a complex interaction of gut microbiome, genetics, medications, lifestyle factors, and diet. Even though it has been agreed that genetics play a substantial role in the development of the condition, only a few genes have been implicated. However, a recent study reported that one of the genes that can be implicated in the development of diverticulitis is the laminin β 4 gene (LAMB4) (Coble et al.,2017). Prior to the findings regarding LAMB4, the Tumor necrosis factor superfamily member 15 (TNFSF15) gene was also found to be associated with the development of diverticulitis.
The Process of Immunosuppression and the Effect It Has On Body Systems
Immunosuppression refers to reduced immune system activation. While some parts of the immune system may possess immunosuppressive effects, immunosuppression can be also be induced (Xe, 2020). The process can be induced by the administration of medications belonging to the class of antidepressants, in some cases to allow organ transplant or bone marrow transplant to prevent a possible rejection. The process of immunosuppression may come from the blockage of intracellular pathways necessary for recognizing antigen or other immune response systems or when the immune effector cells are killed (Xe, 2020). Immunosuppression, especially when persistent, exposes an individual to the risk of cancer, especially virus-connected cancers. The effects of immunosuppression induced by ultraviolet ratio or ionizing or pharmaceutical drugs depend on the dosage or the intensity used as higher dosage or intensity lead to enhanced effects on the body systems (Xe, 2020). Even though not common, immunosuppression induced for an organ transplant can lead to metastatic tumor cells or occult tumors within the organs or tissues. The occult metastatic melanoma is dangerous for the individual receiving the transplanted organ and tissue.
Conclusion
In conclusion, as an APRN, it is important to understand effective patient diagnosis for effective treatment. It allows careful analysis of symptoms to come up with the best management strategy. This write-up has explored a case study of a patient presenting with various symptoms. After an analysis, it was noted that the symptoms could be coming from recurring diverticulitis.
References
Coble, J. L., Sheldon, K. E., Yue, F., Salameh, T. J., Harris, III, L. R., Deiling, S., … & Broach, J. R. (2017). Identification of a rare LAMB4 variant associated with familial diverticulitis through exome sequencing. Human molecular genetics, 26(16), 3212-3220. https://doi.org/10.1093/hmg/ddx204.
Karaca, T., & Aslan, S. (2018). Effect of ‘nursing terminologies and classifications’ course on nursing students’ perception of nursing diagnosis. Nurse education today, 67, 114-117. https://doi.org/10.1016/j.nedt.2018.05.011
Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282-1298. https://doi.org/10.1053/j.gastro.2018.12.033.
He, X. (Ed.). (2020). Immunosuppression. BoD–Books on Demand.