NURS-6501N 42 Advanced Pathophysiology

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

A mother brings her 6-month-old daughter to the HCP for evaluation of possible colic. The mother says the baby has had many episodes of crying after eating and, despite having a good appetite, is not gaining weight. The mother says the baby’s belly “gets all swollen sometimes.” The mother says the baby tastes “salty” when the mother kisses the baby. Further work up reveals a diagnosis of cystic fibrosis. The mother relates that her 23-month-old son has had multiple episodes of “chest congestion” and was hospitalized once for pneumonia. The mother wants to know what cystic fibrosis is and she also wants to know if she should have any more children.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.

By Day 7 of Week 2

Submit your Case Study Analysis Assignment by Day 7 of Week 2.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

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Advanced Pathophysiology

Introduction

The case study involves a 42-year-old man who presented with complaints about redness, pain, fever, and swelling of the right calf. The patient had accidentally cut himself on the leg using a string trimmer while working. This paper will discuss the possible diagnosis for the patient including the reasons he manifested the symptoms. The paper will also discuss the process of immunosuppression and the gene associated with the diagnosis.

The patient presented with the symptoms due to cellulitis as he presented with pain, redness, fever, chills, and swelling on the right calf. The patient sustained a cut on the leg while working. According to Sullivan & de Barra (2018), cellulitis is normally caused when bacteria get in a wound or an area without skin, for example after a cut. The most common type of bacteria associated with cellulitis are streptococci such as Group A ß – hemolytic streptococcus (Strep and Streptococcus pneumoniae (Strep) (Sullivan & de Barra (2018). Symptoms of cellulitis include redness of the skin, dimpling of the skin, tenderness, pain, fever, red spots, swelling (Sullivan & de Barra, 2018). Cellulitis also occurs on one side of the body. The bacteria must have entered through the cut that he sustained and when he cleaned the open area using water from the garden. The patient manifested the majority of these symptoms and also the swelling was on the right calf hence the most likely diagnosis is cellulitis. When left untreated, the bacteria can spread to the bloodstream and lymph nodes leading to a life-threatening condition such as sepsis.

The gene that is commonly attributable to cellulitis is the tumor necrosis factor (TNF). TNF is a multifactorial cytokine that regulates various cellular activities such as survival, proliferation, and death of the cells (Lee et al., 2018). TNF regulates pathways such as ERK signaling and the innate immune system. Inflammatory cells secret TNF, causing inflammation. When there is an infection, the number of TNF increases (Lee et al., 2018). Therefore, in this patient, the bacterial infection that occurred when the bacteria entered through the cut caused a local increase of the TNF. According to Lee et al (2018), a local elevation in the concentration of TNF triggers inflammation that is associated with symptoms such as fever, redness, pain, swelling, and loss of function. The immune system used the TNF gene for cell signaling where when white blood cells detect an infection, TNF is released to inform other immune system cells in order to trigger an inflammatory response.

Immunosuppression occurs when the immune system is not working adequately. This means that the body’s immune system is not functioning well and this includes all the immune defense systems such as the white blood cells (Sarin et al., 2019). Therefore, the immune system of a person with immunosuppression cannot fight infections effectively. As a result, people with immunosuppression are at an increased risk of developing infections including the progress of minor skin infections to cellulitis.

Conclusion

The patient’s diagnosis is cellulitis, an infection that takes place whenever bacteria enter in the blood via an open cut on the skin. The objective and subjective data supports the diagnosis of cellulitis for this patient. TNF gene is associated with cellulitis because the gene triggers inflammation. Immunosuppression reduces the functionality of the immune system increasing an individual’s susceptibility to infections like cellulitis.

References

Lee, W. J., Lee, T. A., Suda, K. J., Calip, G. S., Briars, L., & Schumock, G. T. (2018). Risk of serious bacterial infection associated with tumor necrosis factor-alpha inhibitors in children with juvenile idiopathic arthritis. Rheumatology, 57(2), 273-282.

Sarin, H. V., Gudelj, I., Honkanen, J., Ihalainen, J. K., Vuorela, A., Lee, J. H., … & Perola, M. (2019). Molecular pathways mediating immunosuppression in response to prolonged intensive physical training, low-energy availability, and intensive weight loss. Frontiers in immunology, 10, 907.

Sullivan, T., & de Barra, E. (2018). Diagnosis and management of cellulitis. Clinical medicine (London, England), 18(2), 160–163. https://doi.org/10.7861/clinmedicine.18-2-160