NR 507
Week 1 – Part 1, 2 & 3
Case Study Discussions and Quiz
, NR 507 Week 1 TD and Quiz
PART 1:
John is a 19-year-old college football player who presents with sneezing,
itchy eyes, and nasal congestion that worsens at night. He states that he has a
history of asthma, eczema and allergies to pollen. There is also one other
person on the football team that has similar symptoms. His vitals are BP
110/70, P 84, R 18, T 100 F.
Write a differential of at least three (3) possible items from the most
likely to less likely. For each disease include information about the
epidemiology, pathophysiology and briefly argue why this disease fits
the presentation and why it might not fit the presentation.
Nasal congestion viral rhinitis, allergic rhinitis, sinusitis, rhinitis
medicamentosa (rebound from nasal decongestants)
Sneezing allergic rhinitis, URI
DX:
1. Allergic response to stimulant from being outside – i.e. allergic rhinitis/
sinusitis?
2. Viral rhinitis /URI?
3. Bacterial rhinitis/ sinusitis?
“Type 1 allergic responses mediators (such as epinephrine, acetylcholine,
and inflammatory mediators) bind to receptors on mast cells and the target
cells of inflammation (i.e. smooth muscle), thereby controlling the release of
inflammatory mediators from mast cells and the degree to which target cells
respond to inflammatory mediators (p. 272).
, Differential Diagnoses:
1. Allergic Rhinitis. Since John reports a history of allergies, specifically to pollen,
he could be experiencing an exacerbation of his allergies.
Epidemiology: The increasing prevalence of allergic rhinitis has epidemiologists
questioning what changed. The rise was too quick to be attributed to genetics,
therefore epidemiologist deduce that it is environment related (Platts-Mills &
Commins, 2017). Indoor and outdoor allergen exposure has increased since the
1800’s, which likely influenced the development of allergic rhinitis as well as
asthma (Platts-Mills & Commins, 2017). Allergic rhinitis is one of the most IgE-
mediated diseases (Sin & Togias, 2010). When an allergen is inhaled, a type 1
hypersensitivity reaction begins, which ultimately results in a reaction that is both
immunological and biochemical (Sin & Togias, 2010). Pollen is an allergen that
can set this reaction into motion.
Pathophysiology: “Type 1 reactions are mediated by antigen-specific IgE and the
products of tissue mast cells” (McCance, Huether, Brashers, & Rote, 2013, p.
263). When a person experiences repeated exposure to such an antigen (i.e.
pollen), IgE production is enhanced and the person becomes sensitized (McCance,
Huether, Brashers, & Rote, 2013, p. 263). When more exposure with the antigen
occurs, a molecule from the antigen binds “simultaneously to two molecules of
IgE-Fc receptor complexes on the mast cell’s surface (cross-link) resulting in
activation of intracellular signaling pathways and mast cell degranulation”
(McCance, Huether, Brashers, & Rote, 2013, p. 265). Mast cell degranulation
products stimulate an acute inflammatory response (McCance, Huether, Brashers,
& Rote, 2013).
IgE is synthesized by B –lymphocytes by way of cytokines (Sin & Togias, 2010).
When basophils and mast cells react, they produce an allergic reaction at the
cellular level (Sin & Togias, 2010).
Presentation of Disease: Allergic rhinitis is characterized by signs and symptoms
that include sneezing, nasal obstruction, rhinorrhea, postnasal drip, fatigue, and
itchy eyes, nose, and throat (DeShazo & Kemp, 2017). When considering rhinitis,
allergy and infection should be considered (Sin & Togias, 2010). However,
allergic rhinitis does best fit the symptoms the patient is exhibiting.
2. Viral Rhinitis. Since there is another person on John’s team experiencing similar
symptoms, John’s symptoms could be viral. John and his teammate share some of
the same physical environment, making them susceptive to this kind of infection.
Epidemiology: Also known as the common cold, more than 200 subtypes of
viruses can cause the common cold (Sexton & McClain, 2017). Viruses can have
seasonal patterns. Rhinoviruses are typically seen in the fall and late spring
(Sexton & McClain, 2017). The common cold can be spread 3 ways: droplets via
small particles, droplets via large particles, and via direct contact (Sexton &
McClain, 2017). Viruses can remain viable on skin for approximately 2 hours post
contact (Sexton & McClain, 2017). The rhinovirus, which is one of the most
common viruses that cause the common cold, can live on surfaces for many
hours, therefore increasing the chance of transmission (Sexton & McClain, 2017).
Week 1 – Part 1, 2 & 3
Case Study Discussions and Quiz
, NR 507 Week 1 TD and Quiz
PART 1:
John is a 19-year-old college football player who presents with sneezing,
itchy eyes, and nasal congestion that worsens at night. He states that he has a
history of asthma, eczema and allergies to pollen. There is also one other
person on the football team that has similar symptoms. His vitals are BP
110/70, P 84, R 18, T 100 F.
Write a differential of at least three (3) possible items from the most
likely to less likely. For each disease include information about the
epidemiology, pathophysiology and briefly argue why this disease fits
the presentation and why it might not fit the presentation.
Nasal congestion viral rhinitis, allergic rhinitis, sinusitis, rhinitis
medicamentosa (rebound from nasal decongestants)
Sneezing allergic rhinitis, URI
DX:
1. Allergic response to stimulant from being outside – i.e. allergic rhinitis/
sinusitis?
2. Viral rhinitis /URI?
3. Bacterial rhinitis/ sinusitis?
“Type 1 allergic responses mediators (such as epinephrine, acetylcholine,
and inflammatory mediators) bind to receptors on mast cells and the target
cells of inflammation (i.e. smooth muscle), thereby controlling the release of
inflammatory mediators from mast cells and the degree to which target cells
respond to inflammatory mediators (p. 272).
, Differential Diagnoses:
1. Allergic Rhinitis. Since John reports a history of allergies, specifically to pollen,
he could be experiencing an exacerbation of his allergies.
Epidemiology: The increasing prevalence of allergic rhinitis has epidemiologists
questioning what changed. The rise was too quick to be attributed to genetics,
therefore epidemiologist deduce that it is environment related (Platts-Mills &
Commins, 2017). Indoor and outdoor allergen exposure has increased since the
1800’s, which likely influenced the development of allergic rhinitis as well as
asthma (Platts-Mills & Commins, 2017). Allergic rhinitis is one of the most IgE-
mediated diseases (Sin & Togias, 2010). When an allergen is inhaled, a type 1
hypersensitivity reaction begins, which ultimately results in a reaction that is both
immunological and biochemical (Sin & Togias, 2010). Pollen is an allergen that
can set this reaction into motion.
Pathophysiology: “Type 1 reactions are mediated by antigen-specific IgE and the
products of tissue mast cells” (McCance, Huether, Brashers, & Rote, 2013, p.
263). When a person experiences repeated exposure to such an antigen (i.e.
pollen), IgE production is enhanced and the person becomes sensitized (McCance,
Huether, Brashers, & Rote, 2013, p. 263). When more exposure with the antigen
occurs, a molecule from the antigen binds “simultaneously to two molecules of
IgE-Fc receptor complexes on the mast cell’s surface (cross-link) resulting in
activation of intracellular signaling pathways and mast cell degranulation”
(McCance, Huether, Brashers, & Rote, 2013, p. 265). Mast cell degranulation
products stimulate an acute inflammatory response (McCance, Huether, Brashers,
& Rote, 2013).
IgE is synthesized by B –lymphocytes by way of cytokines (Sin & Togias, 2010).
When basophils and mast cells react, they produce an allergic reaction at the
cellular level (Sin & Togias, 2010).
Presentation of Disease: Allergic rhinitis is characterized by signs and symptoms
that include sneezing, nasal obstruction, rhinorrhea, postnasal drip, fatigue, and
itchy eyes, nose, and throat (DeShazo & Kemp, 2017). When considering rhinitis,
allergy and infection should be considered (Sin & Togias, 2010). However,
allergic rhinitis does best fit the symptoms the patient is exhibiting.
2. Viral Rhinitis. Since there is another person on John’s team experiencing similar
symptoms, John’s symptoms could be viral. John and his teammate share some of
the same physical environment, making them susceptive to this kind of infection.
Epidemiology: Also known as the common cold, more than 200 subtypes of
viruses can cause the common cold (Sexton & McClain, 2017). Viruses can have
seasonal patterns. Rhinoviruses are typically seen in the fall and late spring
(Sexton & McClain, 2017). The common cold can be spread 3 ways: droplets via
small particles, droplets via large particles, and via direct contact (Sexton &
McClain, 2017). Viruses can remain viable on skin for approximately 2 hours post
contact (Sexton & McClain, 2017). The rhinovirus, which is one of the most
common viruses that cause the common cold, can live on surfaces for many
hours, therefore increasing the chance of transmission (Sexton & McClain, 2017).
