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 IgEmediated 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).
Pathophysiology: Viruses are simple organisms when compared to human
cells and bacteria (McCance, Huether, Brashers, & Rote, 2013). The
classification of a virus depends on the format of their nucleic acid in the
virion; this format is either RNA or DNA and if it is single-stranded or double-
stranded (McCance, Huether, Brashers, & Rote, 2013). The classification also
depends on if the virus uses the reverse transcriptase (RT) enzyme to
replicate (McCance, Huether, Brashers, & Rote, 2013). Seven classifications of
viruses are present; ssRNA + sense (+ sense works as mRNA) represents the
rhinovirus (McCance, Huether, Brashers, & Rote, 2013). Therefore, the
rhinovirus is an RNA virus that does not have an envelope around it
(McCance, Huether, Brashers, & Rote, 2013).
Presentation of Disease: Being as John and his teammate exhibit some of
the same symptoms and they share a physical environment where a virus
could easily be passed to one another, this disease may fit the presentation.
There are a few conditions that mimic the common cold, such as allergic
rhinitis and bacterial rhinosinusitis (Sexton & McClain, 2017). One can
distinguish between the common cold and simple rhinitis by their
symptoms; the common cold typically presents with sore throat and cough
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 IgEmediated 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).
Pathophysiology: Viruses are simple organisms when compared to human
cells and bacteria (McCance, Huether, Brashers, & Rote, 2013). The
classification of a virus depends on the format of their nucleic acid in the
virion; this format is either RNA or DNA and if it is single-stranded or double-
stranded (McCance, Huether, Brashers, & Rote, 2013). The classification also
depends on if the virus uses the reverse transcriptase (RT) enzyme to
replicate (McCance, Huether, Brashers, & Rote, 2013). Seven classifications of
viruses are present; ssRNA + sense (+ sense works as mRNA) represents the
rhinovirus (McCance, Huether, Brashers, & Rote, 2013). Therefore, the
rhinovirus is an RNA virus that does not have an envelope around it
(McCance, Huether, Brashers, & Rote, 2013).
Presentation of Disease: Being as John and his teammate exhibit some of
the same symptoms and they share a physical environment where a virus
could easily be passed to one another, this disease may fit the presentation.
There are a few conditions that mimic the common cold, such as allergic
rhinitis and bacterial rhinosinusitis (Sexton & McClain, 2017). One can
distinguish between the common cold and simple rhinitis by their
symptoms; the common cold typically presents with sore throat and cough
