Alterations in Cellular Processes 16-year-old boy

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Alterations in Cellular Processes NURS 6501 week 1 Discussion
Alterations in Cellular Processes

Scenario: A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy Alterations in Cellular Processes NURS 6501 week 1 Discussion. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

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In the case study, the boy is showing signs of an Anaphylaxis reaction or hypersensitivity type one reaction to Amoxicillin. Anaphylaxis is a systemic response to an antigen that can potentially lead to death (Peavy & Metcalfe, 2008). Anaphylaxis can vary in severity, triggers, and symptoms. Triggers for anaphylaxis can include medications, foods, and stinging insects. Anaphylaxis occurs in at least 1 in 50 adults in the United States, showing an increase in prevalence (Wood et al., 2014). In this particular case study, the trigger, or antigen is Amoxicillin.

         Genetics may play a role in hypersensitivity reactions. According to Khoury and Lyons (2019), there may be a link between people with elevated basal serum tryptase and an increase risk in hypersensitivity reactions, although research is still being done. According to Abbas and Moussa (2021), there may be a genetic predisposition to allergic reactions. There was not a lot of data available about the role of genetics in allergic reactions Alterations in Cellular Processes NURS 6501 week 1 Discussion. I do not think there is very clear-cut evidence showing the link between the two at this time. Gender does not seem to play a role in allergic reactions either.

Physiologic Response and Cell Activity

When the boy in the case study ingested the Amoxicillin, this triggered a hypersensitivity response in his body. It appears that the boy has been exposed to Amoxicillin before and his body has been sensitized to it. Sensitization is when there is enough T cells built up where the reaction is noticeable and what triggers the allergic reaction (McCance & Huether, 2019). If he was not sensitized, he would not have had the reaction. During the sensitization process, the antigen is ingested into the body. In this case, the antigen is the Amoxicillin. Once the Amoxicillin is ingested, the antigen- presenting cell comes along and takes in some of the Amoxicillin, breaks it down and puts it on its surface receptors. The antigen-presenting cell travels to the lymph nodes where it meets the T-Helper cells. The antigen-presenting cell presents the antigen to the T-helper cell. The T-helper cells then notify the B-cells that there is a new antigen. The T-helper cells communicate with the B-cells using cytokines. The B-cell is activated into a IgE plasma cell. The IgE cell then binds onto the FC receptors of mast cells and basophils. The body is sensitized at this point. (Peavy & Metcalfe, 2008)

The scenario discussed in the case study happened after sensitization occurred. The mast cells were just floating around in his body waiting to encounter Amoxicillin again. When the boy in the case study ingested Amoxicillin this time, the Amoxicillin is cross linked on the IgE on the mast cells and basophils and it activates the degranulation process. This releases large amounts of histamine and other mediators into the body which causes peripheral vasodilation, increase in vascular permeability, smooth muscle contraction, and bronchospasms (He et al., 2013) Alterations in Cellular Processes NURS 6501 week 1 Discussion. All of these internal changes cause external symptoms. Increasing vascular permeability and vasodilation causes edema and redness to tissues. With the increase in vascular permeability, neutrophils and other cells are able to escape from blood vessels and cause inflammation. Smooth muscle constriction and bronchospasms cause shortness of breath and wheezing. The release of mediators from the mast cells attracts Eosinophils to tissues causing things like itching, eczema, hay fever, angioedema, and asthma (Abbas & Moussa, 2021).

References

Abbas, M., & Moussa, M. (2021). Type I Hypersensitivity Reaction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK560561/

He, S., Zhang, H., Zeng, X., Chen, D., & Yang, P. (2013). Mast cells and basophils are essential for allergies: Mechanisms of allergic inflammation and a proposed procedure for diagnosis. Acta Pharmacologica Sinica, 34(10), 1270–1283. https://doi.org/10.1038/aps.2013.88

Khoury, P., & Lyons, J. J. (2019). Mast cell activation in the context of elevated basal serum tryptase: Genetics and presentations. Current Allergy and Asthma Reports, 19(12). https://doi.org/10.1007/s11882-019-0887-x

McCance, K. L., & Huether, S. E. (2019). Pathophysiology – e-book: The biologic basis for disease in adults and children (8th ed.). Mosby. Alterations in Cellular Processes NURS 6501 week 1 Discussion

Peavy, R. D., & Metcalfe, D. D. (2008). Understanding the mechanisms of anaphylaxis. Current Opinion in Allergy & Clinical Immunology, 8(4), 310–315. https://doi.org/10.1097/aci.0b013e3283036a90

Wood, R. A., Camargo, C. A., Lieberman, P., Sampson, H. A., Schwartz, L. B., Zitt, M., Collins, C., Tringale, M., Wilkinson, M., Boyle, J., & Simons, F. R. (2014). Anaphylaxis in america: The prevalence and characteristics of anaphylaxis in the united states. Journal of Allergy and Clinical Immunology, 133(2), 461–467. https://doi.org/10.1016/j.jaci.2013.08.016

2 months ago

RE: Alterations in Cellular Processes
OLLAPSE
xxx,

In addition to your points, Streptococcus pyogenes, the Group A Streptococcus (GAS), is the most common cause of bacterial pharyngitis in children and adults. Innate and adaptive host immune responses are fundamental for defense against streptococcal pharyngitis and are central to the clinical manifestation of disease. Host immune responses also contribute to the severe poststreptococcal immune diseases that constitute the major disease burden for this organism (nih.gov).

Cell-to-cell adhesions are formed on plasma membranes, thereby allowing the formation of tissues and organs. Cells are held together by three different means: (a) the extracellular membrane, (b) cell adhesion molecules in the cell’s plasma membrane, and (c) specialized cell junctions (McCance & Huether, 2019) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier.

Group A streptococcal pharyngitis: Immune responses involved in bacterial clearance and GAS-associated immunopathologies. Retrieved March 4, 2022, from https://pubmed.ncbi.nlm.nih.gov/28951419/

2 months ago

RE: Alterations in Cellular Processes
COLLAPSE
Hi xx. Great post! I was able to locate some information regarding genetics and allergy risks, although I agree with you that the data is limited. Kanchan et al. report on the correlation between food allergies and genetics (2021). Alterations in Cellular Processes NURS 6501 week 1 Discussion Additionally, Kanchan et al. describe the lack of information and limitations for researchers examining the topic (2021). It has been described that the risk of food allergy increases in the offspring when parental allergies are present (Kanchan et al., 2021). Furthermore, specific genes have been identified in food allergy roles (Kanchan et al., 2021). With the advances of science and genetic research, I am confident that a genetic cause of medication allergies may be identified one day. The case study presented describes an immediate, Type 1 allergic reaction to Amoxicillin. A Type 1 or anaphylactic reaction results from overactive IgE, leading to a histamine response creating the symptoms described in the case study (Justiz-Vaillant & Zito, 2019). Typical signs of anaphylaxis can include swelling of the face, tongue, and airway, low blood pressure, unconsciousness, among others (Justiz-Vaillant & Zito, 2019). Anaphylaxis is considered a medical emergency that can lead to shock and ultimately mortality if left untreated (Justiz-Vaillant & Zito, 2019). Luckily, the patient in the case study recovered without further complication. As a nurse, have you had any personal experiences with a patient having a hypersensitivity? I spent many years treating patients with chemotherapy and blood products, and it was not uncommon for a patient to have an allergic reaction during an infusion.

References

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing.

Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/

Kanchan, K., Clay, S., Irizar, H., Bunyavanich, S., & Mathias, R. A. (2021). Current insights into the genetics of food allergy. The Journal of

 Allergy and Clinical Immunology, 147(1), 15–28. https://doi.org/10.1016/j.jaci.2020.10.039

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2 months ago
RE: Alterations in Cellular Processes
COLLAPSE
Hixxx,

Thank you for the response. As a nurse, I have had a lot of experiences with Anaphylaxis, unfortunately. I have worked in the emergency department for about 11 years now and have cared for multiple patients in Anaphylaxis and have actually received Epinephrine myself for a throat swelling after ingesting Walnuts (my known allergy) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

Discussion: Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor Alterations in Cellular Processes NURS 6501 week 1 Discussion.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.
Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response.
Alterations in Cellular Processes NURS 6501 week 1 Discussion

The Scenario of a 16-year-old boy with sore throat.
The Scenario of a 16-year-old boy with a sore throat complaint.

In the assigned scenario of a 16-year-old boy who presented in the clinic with chief complaint of sore throat for 3 days. Though he denied fever or chills, but his presenting symptoms of low grade fever ( temp 99.9 F) and reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+ positive anterior and posterior cervical adenopathy; this prompted his HCP to perform rapid strep test in the office and it was positive for group A streptococcal (GAS) causing streptococcal pharyngitis known as strep throat. It is a common bacterial infection that can be treated with antibiotics; hence, amoxicillin 500mg p.o. q 12hours x 10 days was prescribed. The 16-year-old developed anaphylactic drug reaction to Amoxicillin which manifested as swelling of his tongue and lips, and difficulty breathing with audible wheezing.

Genetics plays an important role in streptococcal pharyngitis only if there is a family history of recurrent pharyngitis and if some of his family members are carriers of a group A Streptococcal pyogenes. In this scenario, the 16-year-old boy has no family history of recurrent pharyngitis and no one of his family member was a carrier. According to Center for Disease Control and Prevention (CDC, 2018), acute pharyngitis may not be associated with a specific genetic condition.

The physiological response to the stimulus like swelling of the tongue and lips with difficulty breathing is due to drug allergic reaction to amoxicillin taken by the patient. This response occurred due to immune system hyperactivity to the allergen which, in this case, was amoxicillin as stated in McCance & Huether (2019, p.225) that penicillin-based medications like amoxicillin has low molecular weight and cannot trigger immune response until after binding with larger molecules in the blood.

This response occurred because the allergen triggered antibodies immunoglobulin E (IgE) that travels to the cell and releases chemical called histamine. According to Vaillant & Zito (2019), type 1 hypersensitivity reactions mediated by IgE causing anaphylactic response occurring within 24 hours as observed in the 16 -old year patient.

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The cells that are involved in this process are mast cells and basophils. The antibodies bind to mast cells and basophils; these contain histamine granules that are released in the reaction, causing inflammation (Vailliant & Zito,2019).

Another characteristic that would change my response is genetics because some families may genetically be predisposed to recurrent group A streptococcal infections; however, gender does not play a role in contracting pharyngitis. Moreover, strep throat is common among ages 5 to 16.

Reference

Center for Disease Control and Prevention (2018). Pharyngitis (Strepthroat): Information for clinicians.cdc.gov.

McCance,K. & Huether, S (2019) Pathophysiology: The biological basis for disease in adult and children (8th ed). Mosby.

Vaillant, J & Zito, P (2019). Immediate hypersensitivity reactions (NCBI Bookshelf) StatPearls Publishing.

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat.

Good work on your discussion. The immune system is an integral part of protection against disease. However, some normally protective immune mechanisms can sometimes cause detrimental reaction. These hyper sensitivity reactions can be divided into 4 types:

Type I reaction: immediate hypersensitivity reaction involves immunoglobulin (IgE)-mediated release of histamine and other mediators from mast cells and basophils. Examples include anaphylaxis and allergic rhinoconjunctivitis.

Type II reaction: cytotoxic hypersensitivity reactions involve immunoglobulin G or M antibodies bound to cell surface antigens, with subsequent complement fixation. An example is drug induced hemolytic anemia.

Type III reactions: immune-complex reactions involve circulating antigen-antibody immune complexes that deposit in postcapillary venules, with subsequent complement fixation. An example of this type of reaction is serum sickness.

Type IV reactions: delayed hypersensitivity reactions, cell-mediated immunity are mediated by T cells rather than by antibodies. An example is contact dermatitis from poison ivy or nickel allergy.

Understanding the different types of reactions is important for the provider so an accurate diagnosis and treatment plan can be established Alterations in Cellular Processes NURS 6501 week 1 Discussion.

Dr.

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat.
COLLAPSE

Thanks for your comment and input that simplified the four types of hyperactivity reactions.

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat, reply #1 from LloydT

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat, reply #1 from LloydT

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat.

2 months ago
RE: Response

Alterations in Cellular Processes NURS 6501 week 1 Discussion Great! Thank you for your educational post. Having an allergic reaction to medications can be mild or severe. The 16 years old’s signs and symptoms show that he was having an anaphylactic reaction. It is life-threatening characterized by airway problems, difficulty breathing, and circulatory problems, and is associated with skin and mucosal changes (Reber et al, 2017). Eosinophils, mast cells, and Basophils are all involved in the pathogenesis of allergic disease, and their pathological roles are linked with the presence of immunoglobulin E (IgE) antibodies (Metcalfe et al., 2016).

Reference:

Metcalfe, Dean D., Ruby Pawankar, Steven J. Ackerman, Cem Akin, Frederic Clayton, Franco H. Falcone, Gerald J. Gleich, et al. “Biomarkers of the Involvement of Mast Cells, Basophils and Eosinophils in Asthma and Allergic Diseases.” World Allergy Organization Journal 9 (2016): 7. https://doi.org/10.1186/s40413-016-0094-3.

Reber, Laurent L., Joseph D. Hernandez, and Stephen J. Galli. “The Pathophysiology of Anaphylaxis.” Journal of Allergy and Clinical Immunology 140, no. 2 (August 2017): 335–48. https://doi.org/10.1016/j.jaci.2017.06.003.

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat. Response #2

I really enjoyed reading your discussion post this week, you brought up a lot of good points. Alterations in Cellular Processes NURS 6501 week 1 Discussion The fact that the child did not have any known family history of Strep throat is important because some research has been found that Strep throat can be genetic. It has been found that some children develop strep throat and tonsil infections because they have a gene that prevents them from developing immunity. Researchers have found that strep throat did run in some families (Citroner, 2019). Also, research has found that people with an allergy to Penicillin have a genetic variation in their immune system (Erdmann, 2020).

The physiological response that the child had with the swelling of the lips and tongue and wheezing was in inflammatory response to his allergy to Penicillin. Drugs may cause allergic reactions by any mechanism of hypersensitivity. Allergic inflammation includes several inflammatory cells including mast cells, basophils, lymphocytes, dendritic cells, eosinophils, and sometimes neutrophils (Barnes, 2011).

References

Barnes, P., (2011). Pathophysiology of allergic inflammation. National Library of Medicine. Https://pubmed.ncbi.nlm.nih.gov/21682737.

Citroner, G. (2019). Here’s why certain kids repeatedly get strep throat. Healthline. https://www.healthline.com/health-news/why-your-kid-keeps-getting-strep-throat

Erdmann, J. (2020). Penicillin allergies may be linked to one immune system gene. Science News. https://www.sciencenews,org

2 months ago

RE: The Scenario of a 16-year-old boy with sore throat.
Hello XX, you have highlighted very important points. Alterations in Cellular Processes NURS 6501 week 1 Discussion Through your post I have had time to read more about streptococcal Pharyngitis and how family history contributes to the likelihood of an individual developing the allergy. In this scenario, Genetics play a significant role in drug allergy reactions. Drug allergy occurs as a simultaneous reaction between the drug and the immune system. HLA alleles are the risk factors that aid the development of severe allergic reaction after drug administration (Finberg & Guharoy, 2012). Identifying people showing severe allergic reactions that could be fatal helps in improving patient care. The boy presented the specific described symptoms due to being hypersensitive to amoxicillin drugs. When the boy was exposed to amoxicillin, which is the specific allergen in this scenario, his body produces specific antibodies. The produces antibodies are Basophils found in the blood streams (Pourpak et al.,2008). The allergen introduced in the body joined together with the basophils bringing about an antibody-antigen reaction. This resulted to the breakage of the basophils which instigated the occurrence of swelling of the tongue and lips, difficulty in breathing and audible whizzing. Health providers ought to normalize carrying out antibiotic tests before administering and prescribing drugs. This will help arrest severe allergic drug reaction which could turn out to be fatal.

References

Finberg, R. W., & Guharoy, R. (2012). Understanding Drug Allergies and Drug Toxicities. In

Clinical Use of Anti-infective Agents (pp. 85-96). Springer, New York, NY.

Pourpak, Z., Fazlollahi, M. R., & Fattahi, F. (2008). Understanding adverse drug reactions and

drug allergies: principles, diagnosis and treatment aspects. Recent patents on

        inflammation & allergy drug discovery, 2(1), 24-46.

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat.
The physiologic response can further be broken down. The release of histamine and will cause vasodilation and increase in vascular permeability. Increase in vascular permeability causes extravasation of neutrophils and other inflammatory cells to leak out of the blood vessels. This is what causes redness, swelling, low blood pressures, syncope, and things like that in the early phase of Hypersensitivity Type 1 (He et al., 2013) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

According to Weiss (2002), there has been a correlation between childhood exposure to germs and a decrease prevalence of hay fever, allergic asthma, and allergic sensitization. This article talks about how children that were raised on farms were shown to have a lower prevalence of these illnesses than children who were not. Although there are many theories about this data, there is no clearcut evidence that I found on the genetic level to show any changes.

References

He, S., Zhang, H., Zeng, X., Chen, D., & Yang, P. (2013). Mast cells and basophils are essential for allergies: Mechanisms of allergic inflammation and a proposed procedure for diagnosis. Acta Pharmacologica Sinica, 34(10), 1270–1283. https://doi.org/10.1038/aps.2013.88

Weiss, S. T. (2002). Eat dirt — the hygiene hypothesis and allergic diseases. New England Journal of Medicine, 347(12), 930–931. https://doi.org/10.1056/nejme020092

2 months ago
RE: The Scenario of a 16-year-old boy with sore throat.
Hello xxx, i agree with your assessment of the child having both a sore throat (strep) and also having a allergic reaction to Amoxicillin his MD prescribed for him. Anaphylaxis is a serious emergency that can lead to life threatening failure, it is caused as you mentioned by a IgE-mediated cell response that causes a sudden release of histamine. According to Vaillant & Zito.,2019 anaphylactic responses are mediated by iGE that then produces a immune response to environmental proteins, it then binds to mast cells and basophils which contains the histamine which causes the reaction, as evidenced with the child having a swollen lip that progressed to difficulty breathing.

Reference:

Vaillant,J & Zito,p (2019). Immediate Hypersensitivity Reaction( NCBI) Statspearl Publishing. Retrieved March 8th, 2022 from https://content.waldenu.edu/content/dam/laureate/laureate-academics/wal/ms-nurs/nurs-6501/week-01/Justiz-Vaillant_Immediate%20Hypersensitivity%20Reactions.pdf Alterations in Cellular Processes NURS 6501 week 1 Discussion

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