Donna, a twenty-one-year-old nursing student, comes to her nurse practitioner in December with a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every spring and fall.
Physical Examination
Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Answer the questions about Donna and her condition and provide a pathophysiological response in the body. Examine and describe the pathophysiology associated with the possible disease.
- What is the possible disease process according to the client’s history?
- What assessment questions would be useful to ask about her medical and family history?
- What evidence presented in the case study suggest that Donna does not have an acute severe infection?
- If Donna has allergic rhinitis, what type of hypersensitivity reaction is involved?
Expert Solution Preview
Introduction:
In this case study, a nursing student named Donna has presented with symptoms of itchy eyes, nasal congestion, watery nasal discharge, cough, sneezing, and a history of seasonal allergies, possibly indicating an allergic response. This answer will focus on providing a pathophysiological response to these symptoms associated with the possible disease.
1. What is the possible disease process according to the client’s history?
Donna’s symptoms suggest that she may be suffering from allergic rhinitis, also known as hay fever. Allergic rhinitis is a condition in which the immune system overreacts to allergens like pollen, dust mites, pet dander, or mold spores. This overreaction triggers an immune response that leads to inflammation, causing the typical symptoms of itchy eyes, runny nose, sneezing, and coughing.
2. What assessment questions would be useful to ask about her medical and family history?
When assessing Donna’s medical and family history, it would be useful to ask about any allergies or allergic conditions that she or any of her family members may have. Additionally, questions about her occupation, exposure to environmental triggers, and any medications or supplements that she is currently taking can help to identify potential underlying factors contributing to her current condition.
3. What evidence presented in the case study suggests that Donna does not have an acute severe infection?
Donna’s clear lung sounds on auscultation and normal vital signs including respiratory rate, pulse, and blood pressure suggest that she does not have an acute severe infection. Additionally, the absence of a high fever and other severe symptoms such as shortness of breath or chest pain indicates that her condition is most likely not due to an acute infection.
4. If Donna has allergic rhinitis, what type of hypersensitivity reaction is involved?
Allergic rhinitis is a type I hypersensitivity reaction, which is also referred to as an immediate hypersensitivity reaction. In this type of reaction, the immune system produces IgE antibodies in response to an allergen, triggering a cascade of inflammatory mediators. This results in the release of histamine, leukotrienes, and other chemicals that cause the classic symptoms of allergy, such as itching, swelling, and congestion.
