NR507 Week 1 Case Study_ Allergic Rhinitis Diagnosis and
Treatment
Pathophysiologyy&yClinicalyFindingsyofytheyDisease
1. Identifyytheycorrectyhypersensitivityyreaction:
Theylikelyydiagnosesyofythisypatientywouldybeyallergicyrhinitisy(AR),yrelatedytoyheryenvironment.yPatentypresentedyw
ithyrhinorrhea,ysneezing,yandychronicynasalystuffiness.yDiagnosisyofyARycanybeyachievedyfromyaccurateydescriptiony
ofysymptomsyasywellyasyaypersonalyandyphysicalyexamyandyenvironmentalyfactors.yIdentificationyofyARyisyusuallyyc
onfirmedyafteryinitiationyofymedicalytreatment,ysuchyasyantihistamines.yIfyaypatientyrespondsywellytoythis,ythenyityisyc
onformedythatytheycorrectyhypersensitivityyreactionyidentifiedy(NHS,y2019).yAyproviderycanyalsoyidentifyytheytrigge
rsythroughyskinyprickytest,ypatchytestyoryintradermalytestythroughyanyallergistytoydetermineytheirysensitivitiesy(Americ
anyCollegeyofyAllergy,yAsthma,yandyImmunology,y2020).
2. Explainytheypathophysiologyyassociatedywithytheychosenyhypersensitivityyreactiony Allergicy rhinitisy isy ato
picy diseasey wherey histaminey andy leukotrienesy arey responsibley for
rhinorrhea,ysneezing,yandynasalyobstruction.yTheyanaphylacticyresponseyisymediatedybyyIyantigenyspecificyimmunogl
obulinyEyantibodiesythatyareyproducedybyytheyimmuneysystemyinyresponseytoyenvironmentalyproteinsy(McCance,y&y
Huether,y2019).y Theseyantibodiesy(IgE)ybindytoymastycellsyandybasophils,ywhichycontainyhistamineygranulesythatyar
eyreleasedyinytheyreactionytoyexposureytoycertainyallergens.yUponyactivation,ytheymastycellyreleasesyspecificymolecule
s,ywhichyincludeyhistaminesyandychemotacticyfactors.yThisyearly-
phaseyreactionyisycharacterizedybyymastycellydegranulation,ywhichycausesyinflammationyandyrapidyonsetyofyacuteynas
alysymptomsy(i.e.,ysneezingyandyrhinorrhea)yandytheyemergenceyofyocularysymptomsy(i.e.,yitching,yredness,yandywat
ering)y(Bjermer,yWestman,yHolmström,y&yWickman,y2019).yAndytheylateyphaseytakesyplaceyonceyhistamineyandyoth
eryproinflammatoryymoleculesybindywithymucosalyreceptors,ythisycausesymastycelly synthesis.yInythisyphase,ythereyisy
ayrapid,ybutytemporaryy constrictiony ofysmoothymuscle
y
, Weeky1yCaseyStudyyTemplate
andydilationyofytheyadjacentyvenules,yincreasingyoedema.yThisyincreaseyinypressureyandyfluidyperpe
tuatesynasalycongestionyandystuffiness.
3. Identifyyatyleastythreeysubjectiveyfindingsyfromytheycase:
Theysubjectiveyfindingsyasyitypresentedyinytheycaseystudy,ytheypatientystatedythatysheywasyexperienc
ingyrhinorrhea,ysneezing,yandypersistentynasalystuffiness.
4. Identifyyatyleastythreeyobjectiveyfindingsyfromytheycase:
Theyobjectiveyfindingsywouldybeyobservationsymadeyduringytheyphysicalyexam.yInytheycaseyofyAR,y
theypractitioneryshouldyexpectytoyobserveyrhinorrhea,ybluishyorypaleyswellingyofytheynasalymucosa,y
ocularyissuesylikeyswollenyconjunctivaeyandywateryydischargey(AmericanyAcademyyofyOtolaryngo
logyy-yHeadyandyNeckySurgeryyFoundation,y2015).
ManagementyofytheyDisease
*Utilize the required Clinical Practice Guideline (CPG) to support your
treatmentyrecommendations.
1. Identifyytwoystronglyyrecommendedymedicationyclassesyforytheytreatmentyofytheyconditio
nyandyprovideyanyexampley(drugyname)yforyeach:
TheyfirstytreatmentyrecommendationyforypatientsywithyARyareyintranasalysteroidsy(INS).yThis
hasybeenyprovenytoysignificantlyydecreaseysymptomsyofynasalymucosayinflammation.yThisytypeyofy
medicationyisyeitherysprayedyoryinhaledyintoytheynasalypassage.yCommonlyyprescribedymedications
yareyFluticasoneypropionatey(Flonase),yasywellyasyBudesonidey(RhinocortypropellantyAQ).yTheysec
ondystronglyyrecommendedymedicationyclassywouldybeysecond-generation,yH1-
receptoryantagonistsywhichyareyoralyantihistamines.yThisyclassyofydrugyworksywellytoyblockytheyacti
onyofyhistamine,yreducingytheyinflammatoryyresponse.yExamplesyofytheseysecond-
generationyantihistaminesyareycetiriziney(Zyrtec)yandyfexofenadiney(Allegra)y(Seidmanyet.al.,yn.d).
y
Treatment
Pathophysiologyy&yClinicalyFindingsyofytheyDisease
1. Identifyytheycorrectyhypersensitivityyreaction:
Theylikelyydiagnosesyofythisypatientywouldybeyallergicyrhinitisy(AR),yrelatedytoyheryenvironment.yPatentypresentedyw
ithyrhinorrhea,ysneezing,yandychronicynasalystuffiness.yDiagnosisyofyARycanybeyachievedyfromyaccurateydescriptiony
ofysymptomsyasywellyasyaypersonalyandyphysicalyexamyandyenvironmentalyfactors.yIdentificationyofyARyisyusuallyyc
onfirmedyafteryinitiationyofymedicalytreatment,ysuchyasyantihistamines.yIfyaypatientyrespondsywellytoythis,ythenyityisyc
onformedythatytheycorrectyhypersensitivityyreactionyidentifiedy(NHS,y2019).yAyproviderycanyalsoyidentifyytheytrigge
rsythroughyskinyprickytest,ypatchytestyoryintradermalytestythroughyanyallergistytoydetermineytheirysensitivitiesy(Americ
anyCollegeyofyAllergy,yAsthma,yandyImmunology,y2020).
2. Explainytheypathophysiologyyassociatedywithytheychosenyhypersensitivityyreactiony Allergicy rhinitisy isy ato
picy diseasey wherey histaminey andy leukotrienesy arey responsibley for
rhinorrhea,ysneezing,yandynasalyobstruction.yTheyanaphylacticyresponseyisymediatedybyyIyantigenyspecificyimmunogl
obulinyEyantibodiesythatyareyproducedybyytheyimmuneysystemyinyresponseytoyenvironmentalyproteinsy(McCance,y&y
Huether,y2019).y Theseyantibodiesy(IgE)ybindytoymastycellsyandybasophils,ywhichycontainyhistamineygranulesythatyar
eyreleasedyinytheyreactionytoyexposureytoycertainyallergens.yUponyactivation,ytheymastycellyreleasesyspecificymolecule
s,ywhichyincludeyhistaminesyandychemotacticyfactors.yThisyearly-
phaseyreactionyisycharacterizedybyymastycellydegranulation,ywhichycausesyinflammationyandyrapidyonsetyofyacuteynas
alysymptomsy(i.e.,ysneezingyandyrhinorrhea)yandytheyemergenceyofyocularysymptomsy(i.e.,yitching,yredness,yandywat
ering)y(Bjermer,yWestman,yHolmström,y&yWickman,y2019).yAndytheylateyphaseytakesyplaceyonceyhistamineyandyoth
eryproinflammatoryymoleculesybindywithymucosalyreceptors,ythisycausesymastycelly synthesis.yInythisyphase,ythereyisy
ayrapid,ybutytemporaryy constrictiony ofysmoothymuscle
y
, Weeky1yCaseyStudyyTemplate
andydilationyofytheyadjacentyvenules,yincreasingyoedema.yThisyincreaseyinypressureyandyfluidyperpe
tuatesynasalycongestionyandystuffiness.
3. Identifyyatyleastythreeysubjectiveyfindingsyfromytheycase:
Theysubjectiveyfindingsyasyitypresentedyinytheycaseystudy,ytheypatientystatedythatysheywasyexperienc
ingyrhinorrhea,ysneezing,yandypersistentynasalystuffiness.
4. Identifyyatyleastythreeyobjectiveyfindingsyfromytheycase:
Theyobjectiveyfindingsywouldybeyobservationsymadeyduringytheyphysicalyexam.yInytheycaseyofyAR,y
theypractitioneryshouldyexpectytoyobserveyrhinorrhea,ybluishyorypaleyswellingyofytheynasalymucosa,y
ocularyissuesylikeyswollenyconjunctivaeyandywateryydischargey(AmericanyAcademyyofyOtolaryngo
logyy-yHeadyandyNeckySurgeryyFoundation,y2015).
ManagementyofytheyDisease
*Utilize the required Clinical Practice Guideline (CPG) to support your
treatmentyrecommendations.
1. Identifyytwoystronglyyrecommendedymedicationyclassesyforytheytreatmentyofytheyconditio
nyandyprovideyanyexampley(drugyname)yforyeach:
TheyfirstytreatmentyrecommendationyforypatientsywithyARyareyintranasalysteroidsy(INS).yThis
hasybeenyprovenytoysignificantlyydecreaseysymptomsyofynasalymucosayinflammation.yThisytypeyofy
medicationyisyeitherysprayedyoryinhaledyintoytheynasalypassage.yCommonlyyprescribedymedications
yareyFluticasoneypropionatey(Flonase),yasywellyasyBudesonidey(RhinocortypropellantyAQ).yTheysec
ondystronglyyrecommendedymedicationyclassywouldybeysecond-generation,yH1-
receptoryantagonistsywhichyareyoralyantihistamines.yThisyclassyofydrugyworksywellytoyblockytheyacti
onyofyhistamine,yreducingytheyinflammatoryyresponse.yExamplesyofytheseysecond-
generationyantihistaminesyareycetiriziney(Zyrtec)yandyfexofenadiney(Allegra)y(Seidmanyet.al.,yn.d).
y
