Adaptive Response

Introduction

Advanced practice nurse is obligated to carry out a rigorous examination of their patients to determine the presence of some disorders in the body. It is therefore imperative to have a comprehensive understanding of how the human body functions to be able to identify abnormalities and hence determine how the body is reacting to changes. Under normal circumstances, a human body responds with compensatory mechanisms when specific changes are initiated in the body system. These compensatory mechanisms usually range from underlying disorders to several signs and symptoms. In a clinical environment, an advanced practice nurse is supposed to identify accurately such responses inclusive of other patient factors with the aim of conducting a diagnosis. The purpose of this paper is to apply nursing knowledge on the given scenarios to explain the pathophysiology, associated alterations, and the patient’s adaptive responses to the alternations caused by the disease process. A mind map constituting the factors mentioned above will be constructed. 

Scenario One: Jennifer (Tonsillitis Or Pharyngitis)

Jennifer has swollen tonsils and diffuse exudates, which is a sign of tonsillitis or pharyngitis. Such epidemiological factors are usually associated with the pediatric pathological situation. The situation occurs due to an infection by group-A beta-hemolytic streptococcus bacterial infection. Pharyngitis is usually caused by viral or bacterial infections that tend to affect the host’s innate immune system. Such an attack leads to the development of diffuse exudates, and it is carried out by micropinocytosis of infectious agents (Vincent, Celestin, & Hussain, 2004). The diffuse exudates and 4+ tonsils make the throat to be erythematous. A Pharyngeal inflammation is caused by inflammatory mediators facilitated by interleukins and arachidonic acid metabolites and leads to an increase in the level of fever (McCance, & Huether, 2018). It is therefore clear that Jennifer’s persistent condition is due to the presence of severe tonsillar/pharyngitis. 

Risk factors include unhygienic environment and consumption of contaminated water. The major clinical presentation of pediatric pharyngitis/tonsillitis includes tonsillar exudates, rheumatic (102F-103F), and cervical lymphadenopathy. However, it should be noted that the lymphadenopathy does not have a cough. Such clinical aspects are mainly caused by bacteria pharyngitis (Vincent, Celestin, & Hussain, 2004). The situation is handled through anti-microbial therapies such as antibiotics.

Diagnosis entails an examination to determine the presence of antigen in the body. Such an examination is usually performed on throat swabs to identify bacterial cell cultures. The idea is to determine the presence of viral infections or bacterial infections. Adaptive and innate immune system activation takes place in children as a fight against infection. Such infections caused tonsillitis/pharyngitis in Jennifer. The autonomous nervous system causes chronotropic effects and the homeostatic condition (McCance & Huether, 2018). The situation causes hypothalamus homeostatic temperature and immunological inflammatory factors influencing tonsil swelling. Toll-like-receptors (TLRs) on the other hand generate adaptive immune changes and hence augmenting antimicrobial activity of neutrophils and macrophages. Microbial engulfing through TLRs causes dendritic cells to mature, cell migration occurs, and stimulation of antigen-specific T cells such as CD80 and CD40 act upon the infection through the endosomal pathway (McCance & Huether, 2018). 

Scenario Two: Jack (Irritant Contact Dermatitis)

Jack, who is a 27-year-old, explains that he has experienced symptoms over the last two weeks of flaky red hands. He denies having a feeling of discomfort or pain. However, he notes that he sometimes feels hot on the hands. The idea that he works as a maintenance engineer where there is a shortage of gloves inclusive of the factors above indicates that Jack has been infected with Irritant Contact Dermatitis. According to Hammer and McPhee (2014), the skin’s most basic function is to offer protection against diseases and desiccation by acting as a barrier. Thus, by allowing moisture in, the skin keeps pathogens out. Contact with irritants such as chemicals damages inflammation and epidermal cells. The damage causes heat, loss of function, redness, pain, and swelling (Mostosi & Simonart, 2016). Adaptive responses include vasodilation, which increases the flow of the blood, especially to the injured site. Additionally, vascular permeability provides plasma proteins and leukocytes, as well as, other biochemical mediators to the injured part. The strength of the irritant and exposure time is directly proportional to the level of severity of the damage (Mostosi & Simonart, 2016). Treatment recommendations for Jack include the application of hypo-irritating lotions and cleaners, avoid getting into contact with the irritant, and application of topical steroid cream, especially on his hands.  

Scenario Three: Martha (General Adaptation Syndrome)

Martha, a 65-year-old retired assistant administrator, complains of a lack of appetite, insomnia, and racing heartbeat. She has been living with hypertension for a long term, a situation, which has been controlled through medication. She has also been taking care of her elderly mother who has a hip fracture and hence unable to move. Her current situation is due to depression and stress disorder. A diagnosis shows that her situation is a response to stress. Stress can be due to some factors such as abuse, unemployment, trauma or loss of a family member (Huggett, 2018). According to the scenario, Martha is a retiree and has no or little social outlet. She is unable to get a break from the pressure of taking care of her ailing elderly mother. The genesis of stress starts by brain perception about adaptation, stressful and survival stimuli. The physiological response then graduates to the whole body. Since the body has a nonspecific response to such noxious stimuli, a triad of manifestations takes place resulting in general adaptation syndrome. 

Physiological response to the General Adaptation Syndrome (GAS) involves activation of the sympathetic nervous system hence releasing norepinephrine.  Norepinephrine influences the release of catecholamine by the adrenal gland into the bloodstream (Huggett, 2018). In response to catecholamine, Martha’s physiology loses the ability to control the blood pressure, which was initially under control by medication. Epinephrine augments myocardial contractility and, thus, increases the blood pressure and heart rate (Craft, Gordon, Huether, McCance, & Brashers, 2015). Production of glucocorticoid hormones increases as a response to stress. Glucocorticoid is an essential aspect of the homeostatic of CNS since it controls cognition, mood, sleep, and memory. 

Response to stress varies from one individual to another depending on coping mechanisms and perception of the stressor. Sometimes coping responses can either be maladaptive or adaptive (McCance, & Huether, 2018). Position treatment for Martha’s current condition is to seek professional counseling services, get involved in support groups and socialization, as well as, other similar situations. 

Mind Map for Irritant Contact Dermatitis

Summary and Conclusion

The purpose of this paper was to apply nursing knowledge on the given scenarios to explain the pathophysiology, associated alterations, and the patient’s adaptive responses to the alternations caused by the disease process. A mind map constituting the factors mentioned above has been constructed. Each scenario is unique making it possible to predict that different situations are distinctive to different people. Some situations do not require medication while others need a little treatment and removal of the patient from the environment causing the situation. 

References

Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences.

Huggett, R. J. (2018). Biomarkers: biochemical, physiological, and histological markers of anthropogenic stress. CRC Press.

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children. Elsevier Health Sciences.

Mostosi, C., & Simonart, T. (2016). Effectiveness of barrier creams against irritant contact dermatitis. Dermatology, 232(3), 353-362.

Vincent, M. T., Celestin, N., & Hussain, A. N. (2004). Pharyngitis. American family physician, 69(6), 1465-1470.