Altered Physiology Case Study NURS 6501
A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. The patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg PO every Friday morning, and prednisone 5 mg PO QAM. He states that he has had a fever of up to 101 degrees F for about a week and admits to chills and sweats.
He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.
Why the Patient Presented with the above Symptoms
Invasive aspergillosis chiefly involves the sinopulmonary tract indicating inhalation as the popular route of entry for the fungus. An array of strains of aspergillus are customarily harmless and found throughout the world. However, infection is predominantly in patients with an underlying pulmonary pathology and immunocompromised states of patients with neutropenia, AIDS, recipients of transplants, and those on long-term corticosteroid and other immunosuppressive drugs (Russo et al., 2020).
This patient’s underlying immunosuppressive state, particularly from the chronic rheumatoid, and the immunosuppressive therapy predisposes the patient to impaired phagocytic engulfment, neutrophilic dysfunction, and digestion of the foreign aspergillus.
As a result, this culminates in the destruction of the bronchoalveolar structures of the respiratory system. Ultimately the result is a cough associated with hemoptysis, chest pain, and the systemic reaction of high fevers, diaphoresis, chills, and fatigue.
Genes Associated with the Development of the Disease
Invasive pulmonary aspergillus, a form of ubiquitous mold found in organic matter, is associated with genetic susceptibility in a particular population of patients. Evidence shows that this condition is polygenic. Patients with certain HLA alleles, specifically HLA-DR2, have increased susceptibility to Aspergillus.
Recent studies point out that cases of invasive aspergilloma are associated with single nucleotide polymorphisms located within macrophage-related genes. The genes that greatly influence invasive aspergilloma include; tumor necrosis factor receptors (TNFR 1 and 2), chemokines, cytokines, toll-like receptors (TLRs 4, 5, 6, and 9), and dectins (dectins 1 and 2).
Moreover, in high-risk hematological patients, the genetics involved include ARNT2 and CX3CR1 genes (Lupiañez et al., 2020). The robust evidence renders most immune-compromised patients with an increased risk of genetic modulation, further increasing the susceptibility to an invasive aspergilloma.
Immunosuppression and its Effects on Body Systems
Immunosuppression is a state of reduced efficacy and activation of the immune system due to primary or secondary disorders that predispose patients to a myriad of conditions (McCance & Huether, 2019). The reduced immune status allows colonization of the body systems, particularly from viral, bacterial, protozoal, or even fungal pathogens. As such, the body’s phagocytic activity is impaired by the failed secretion of inflammatory mediators that contains the foreign pathogens at bay (Benvenuto et al., 2018).
Furthermore, immunosuppression predisposes to opportunistic infections commonly affecting the critical organs responsible for optimum functioning (McCance & Huether, 2019). Colonization of the various organ systems leads to diminished function, genetic re-programming, and, ultimately, death.
In the central nervous system, the effects of immunosuppression include the development of opportunistic infections that include tuberculosis, cryptococcosis, and toxoplasmosis. Studies demonstrate that approximately 5-10% of transplant patients manifest with infections, majorly encephalitis, brain abscess, and meningitis.
Ultimately these infections impair the functionality of various brain functions that include cognition, control of bowel and bladder function, ambulation, balance, gait disturbances, and sexual and emotional aspects. Furthermore, immunosuppression is associated with stroke, seizures, encephalopathy, and peripheral neuropathy.
In the respiratory system, reduced immune status leads to colonization and destruction of the alveolar that is responsible for gaseous exchange. As such, pneumonia develops, leading to increased work of breathing and respiratory failure if left untreated. The gastrointestinal system is yet another system affected by a depressed immune state. The deleterious effects of the GIT include reduced mucosal integrity, depletion of gastric acidity, and impaired mucosal regeneration.
References
Benvenuto, L. J., Anderson, M. R., & Arcasoy, S. M. (2018). New frontiers in immunosuppression. Journal of Thoracic Disease, 10(5), 3141–3155. https://doi.org/10.21037/jtd.2018.04.79
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.
Lupiañez, C. B., Martínez-Bueno, M., Sánchez-Maldonado, J. M., Badiola, J., Cunha, C., Springer, J., Lackner, M., Segura-Catena, J., Canet, L. M., Alcazar-Fuoli, L., López-Nevot, M. A., Fianchi, L., Aguado, J. M., Pagano, L., López-Fernández, E., Alarcón-Riquelme, M., Potenza, L., Gonçalves, S. M., Luppi, M., … Sainz, J. (2020). Polymorphisms within the ARNT2 and CX3CR1 genes are associated with the risk of developing invasive aspergillosis. Infection and Immunity, 88(4). https://doi.org/10.1128/IAI.00882-19
Russo, A., Tiseo, G., Falcone, M., & Menichetti, F. (2020). Pulmonary aspergillosis: An evolving challenge for diagnosis and treatment. Infectious Diseases and Therapy, 9(3), 511–524. https://doi.org/10.1007/s40121-020-00315-4
Altered Physiology Instructions
An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.
Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.
An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.
Support your points with primary references (at least 3 ) This would include textbook and a reading from a reputable journal, published in last 5 years, done in APA format for full credit. No Cleveland, Mayo, eMedicine, Medscape, or StatPearls and UpToDate or a CDC fact sheet or patient ed site.
Advanced Pathophysiology Week 2 Case Study Instructions
- A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever.
- The patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning, and prednisone 5 mg po QAM.
- He states that he has had a fever of up to 101 degrees F for about a week and admits to chills and sweats.
- He says he has had more fatigue than usual and reports some chest pain associated with coughing.
- He admits to having occasional episodes of hemoptysis.
- He works as a grain inspector at a large farm cooperative.
- After an extensive workup, the patient was diagnosed with Invasive aspergillosis.
The Assignment
(1- to 2-page case study analysis-this does not include a title page and reference page)
Develop a 1- to 2-page case study analysis in which you:
- Explain why you think the patient presented the symptoms described. (Occupational, exposures/environmental)
- Identify the genes that may be associated with the development of the disease. (The underlying RA and treatment will be the genetic piece with the associated immunocompromised state.)
- Explain the process of immunosuppression and the effect it has on body systems. Be sure to cite your points to support your explanations.
- A paragraph or two will substantively develop each of the questions asked. Use APA format, reference classroom textbooks, peer-reviewed journals reflecting research done in last 5 years.
By Day 5 of Week 2
Remember there is a Safe Assign score is associated with this assignment. If you wait until the end of the week, you may encounter a delay that will incur a late penalty. Please try and give assignments at least 24 hr to clear submission.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. Keep references current, 5 yr. from publication, please, and from primary references like classroom textbooks, and peer-reviewed journals. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates Links to an external site.).
Resources
- McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 7: Innate Immunity: Inflammation and Wound Healing
- Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
- Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
- Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
- Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
- Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
- Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
- Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions Links to an external site.. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.
https://www.youtube.com/watch?v=Jz0wx1-jTds
NURS_6501_Module1_Case Study_Assignment_Rubric
| NURS_6501_Module1_Case Study_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain why you think the patient presented the symptoms described. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Identify the genes that may be associated with the development of the disease. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome Explain the process of immunosuppression and the effect it has on body systems. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||