Case Study 2 Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Select one of the case studies below for your assignment. In your discussion, be sure to evaluate the presence and effects of alterations in the homeostatic state secondary to gender, genetic, ethnic, and temporal variables.

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Case Study 2: Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Patricia was called at work by a woman at the local day care center. She told Patricia to come and pick up her son because he was not feeling well. Her son, 3½-year-old Marshall, had been feeling tired and achy when he woke up. While at daycare, his cheeks had become red, and he was warm to touch. He did not want to play with his friends, and by the time Patricia arrived, he was crying. Later that afternoon, Marshall’s condition worsened. He had fever, chills, a sore throat, runny nose, and a dry hacking cough. Suspecting Marshall had influenza, Patricia wrapped him up and took him to the community health care clinic.

  1. Why did Marshall’s presentation lead Patricia to think he had influenza and not a cold? Why is it important to medically evaluate and diagnose a potential influenza infection?
  2. Describe the pathophysiology of the influenza virus. Outline the properties of influenza A antigens that allow them to exert their effects in the host.
  3. Marshall may be at risk of contracting secondary bacterial pneumonia. Why is this so? Explain why cyanosis may be a feature associated with pneumonia.

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Answer

Differentiating Influenza and Cold

Reviewing case studies equips nurses with skills and knowledge to work with diverse populations and offer effective healthcare interventions. Marshall, Patricia’s son, is brought to the healthcare center with suspected influenza infection(flu). Influenza and cold have major similarities, and both diseases present with fever, tiredness, runny nose, minor aches, and coughing and sneezing. Other symptoms that appear in severe cold or flu include weakness and fatigue, and muscle and body aches. However, both are upper respiratory illnesses, and the major difference is the severity and progression of the illness. Unlike cold, influenza symptoms develop rapidly and progress within hours, thus a major reason for emergency department visits (Giwa et al., 2018). Influenza is more acute than cold, though both are acute illnesses. The symptoms are also more severe than a common cold, prompting worry and action. Symptoms such as sore throat and a dry cough appear in a severe cold after one to two days in a cold unlike in influenza, where they appear after a few hours (Giwa et al., 2018). Patricia’s son was tired and achy in the morning, and by the afternoon, his condition had flared up to include fever, chills, sore throat, nasal drainage, and a dry cough, enough to cause worry and alarm. Considering the disease’s severity and acuteness (fast progression), an individual would think the child has influenza, hence Patricia’s thought train.

The Importance of Medically Evaluating and Diagnosing Influenza

Many upper and lower respiratory diseases present flu-like symptoms, including fever, chills, tiredness, cough, and a runny nose. These conditions include Acute Respiratory Distress Syndrome, Coronavirus, Adenovirus, cytomegalovirus, and Arenaviruses (Fitzner et al., 2018). Treating without a medical evaluation and diagnosis increases the chances of wrong diagnosis and treatment, hence patient deterioration. Influenza death can result, even though cases are rare. Greetn & StGeorge (2018) note that the right diagnosis ensures individuals get the right treatment early, prevents high healthcare costs, and promotes better patient outcomes. Medically evaluating and diagnosing a suspected influenza case is thus integral.

Influenza Pathophysiology

Influenza is a highly contagious disease that results from respiratory fomites or aerosols from an infected person when they talk, sneeze, or cough. Once in the respiratory system, the viral particles cling to the respiratory epithelium. The respiratory epithelium provides a special breeding ground for the bacteria’s propagation. The virus can be found in various body cells, but the hemagglutinin (HA) molecule, the active proteins in influenza, only divide in the respiratory epithelium. Kalil and Thomas (2019) note that the soft palate contains α2,6-linked sialic acids, which provides a good environment for the viruses’ propagation hence the basis for influenza tests. Invasion of the respiratory mucosa causes a cascade of immune responses in the respiratory system and propagates to systemic infections with multiple organ failures. The disease’s severity depends on the involvement of the lower respiratory system (lungs and alveoli). Disease progression depends on the interaction between the virus and the macrophages in the respiratory system, and thus, a weak immune system worsens the infection severity (Kalil & Thomas, 2019).

Invasion of the respiratory epithelium causes epithelial cell death through apoptosis and necrosis. The erosion exposes the endothelium to cytokines and viral antigens, which can cause an immune system overreaction. Inflammation responses and the viral infection causes further damage to the respiratory system hence accumulation of exudate, cough, congestion, and a runny nose (Kalil & Thomas, 2019). If the infection reaches the alveoli, the alveoli collapse, and the affected areas are filled with fluid (pneumonia). The damaged areas cause further inflammation, and the virus may find its way to the bloodstream, explaining the systemic infections such as endocarditis that may occur after influenza.

The properties of influenza A antigens

Viruses contain a specific structure that enables them to cause disease. The influenza virus has certain antigens that contribute to its virulence. The symptoms in Hemagglutinin HA antigen and Neuraminidase membrane glycoproteins are the primary factors that cause virulence in Influenza type A (Fodor & Te Velthuis, 2020). Hemagglutinin HA enables adherence to the respiratory epithelium and the subsequent division of the virus. At the same time, Neuraminidase lowers the mucous viscosity in the upper respiratory tract, allowing the virus to spread (McAuley et al., 2019). Hemagglutinin is also specific and only rapidly affects the respiratory track triggering a rapid immune reaction hence the relatively faster appearance of signs and symptoms. The symptoms are thus rapid. Neuraminidase helps with the release of viral particles after the budding process. It prevents their aggregation and removes sialic acid residues to promote motility. Thus, Hemagglutinin HA helps with attachment and replication while Neuraminidase increases the spread of the viral particles contributing to the high virulence of influenza A virus and its spread.

Why Marshall may be at risk of contracting secondary bacterial pneumonia

Influenza infections are often concurrent with bacterial pneumonia and acute respiratory distress syndrome. Studies show that Staphylococcus aureus and Streptococcus pneumoniae are the most common causes of pneumonia in Influenza patients, and bacterial pneumonia occurs. Kalili and Thomas (2019) state that about 30-40% of individuals with influenza infection report secondary bacterial pneumonia. There are major reasons for the occurrence of secondary bacterial pneumonia. The infection clears the host’s first line of defense (the skin and mucous membranes), making them vulnerable to infections (MacIntyre et al., 2018). Immunocompromised patients and patients at extremes of age (below five and above 65 years) are at more risk of infections from less-virulent bacterial strains (MacIntyre et al., 2018). Infections destroy the epithelium giving way to low-virulence bacteria such as Staphylococcus aureus to cause notorious secondary bacterial pneumoniae. Marshall’s immunity is compromised, and the infection destroyed his respiratory epithelium. Thus, he is at more risk for contracting bacteria pneumonia and thus requires preventative measures.

Pneumonia and Cyanosis

Pneumonia is the inflammation of the lungs. Inflammation causes secretions and exudates in the lungs and upper airway. These secretions and exudate cause airway blockage hence poor airway clearance and lung perfusion. Less air reaches the lungs for gaseous exchange. Pneumonia destroys lung epithelium; the most affected structures are the alveoli. Alveoli walls are one cell thick; hence, when affected, they collapse, reducing the available gaseous exchange surface. Destruction of the epithelium also increases mucous production, filling the non-collapsed alveoli and compromising gaseous exchange. Infections may also affect the endothelium affecting gaseous exchange; lung tissues undergo destruction by the infection, and the immune system hyper responses. The gaseous exchange is severely affected in severe pneumonia, and less oxygen reaches the blood (hypoxemia). Thus, less oxygen reaches the tissues and thus tissues-hypoxia. Oxygenated blood is bright red hence the pink appearance through tissues with less melanin concentration. Deoxygenated blood is dark red hence the dark-blue appearance on tissues such as lips, gums, and mouth with less melanin concentration. Thus, pneumonia can present with cyanosis and hence the need for thorough physical assessment and aggressive management of patients with pneumonia with cyanosis.

References

Fitzner, J., Qasmieh, S., Mounts, A. W., Alexander, B., Besselaar, T., Briand, S., Brown, C., Clark, S., Dueger, E., Gross, D., Hauge, S., Hirve, S., Jorgensen, S., Katz, M. A., Mafi, A Malik, M., McCarron, M., Meerhoff, T., Mori, Y., and Vandemaele, K. (2018). Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection. Bulletin of the World Health Organization96(2), 122. https://doi.org/10.2471/BLT.17.194514

Fodor, E., & Te Velthuis, A. J. (2020). Structure and function of the influenza virus transcription and replication machinery. Cold Spring Harbor perspectives in medicine10(9), a038398. https://doi.org/10.1101/cshperspect.a038398

Giwa, A. L., Ogedegbe, C., & Murphy, C. G. (2018). Influenza: diagnosis and management in the emergency department. Emergency medicine practice20(12), 1-20.

Green, D. A., & StGeorge, K. (2018). Rapid antigen tests for influenza: rationale and significance of the FDA reclassification. Journal of clinical microbiology56(10), e00711-18. https://doi.org/10.1128/JCM.00711-18

MacIntyre, C. R., Chughtai, A. A., Barnes, M., Ridda, I., Seale, H., Toms, R., & Heywood, A. (2018). The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza an (H1N1) pdm09. BMC infectious diseases18(1), 1-20. https://doi.org/10.1186/s12879-018-3548-0

McAuley, J. L., Gilbertson, B. P., Trifkovic, S., Brown, L. E., & McKimm-Breschkin, J. L. (2019). Influenza virus neuraminidase structure and functions. Frontiers in microbiology10, 39. https://doi.org/10.3389/fmicb.2019.00039

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