Running a temperature
Consider the following scenarios:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.
- Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
- Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
- Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
Write a 2- to 3-page paper that addresses the following:
- Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
- Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
ADAPTIVE RESPONSE 1
The body develops various adaptive responses to deal with particular foreign invaders. The body has the ability to shape the response in way that it response to various attacks, body injury or just body exhaustion. This paper analyses the adaptive responses that is seen as symptoms for various scenarios. The first scenario is that of two year old experiencing running temperature and sore throat. This is diagnosed as Throat infection. The second scenario of the 27 year old man is diagnosis as Allergic contact Dermatitis while the third scenario is diagnosed as depression.
Scenario 1: Throat Infection or Tonsillitis
The disorder depicted in the scenario of a throat infection of Tonsillitis. The infection may have been caused bacteria known as streptococcus that causes inflation of the tonsils, which also affects the surrounding parts (Bathala & Eccles, 2013). The adaptive responses of the throat infection include fever and having hurting throat. Jenifer, a 2-year-old experiencing running temperature and fever of between 101 and 103.2oF is one of the adaptive responses when the body cells fight the virus or the bacterial infection. The body also reacts by through headaches, dysphasia, and loss of appetite. Although the mother has tried to manage the temperature with ibuprofen, the fever has been on and off.
According to Oomen, Modi & Stewart, (2012), Jenifer in this scenario also experiences Tympanic membranes that are reddened on the periphery and erythematous of 4+ tonsils that are defused in the exudates. The fever levels of up to 104 are not very harmful since in children since it is a reaction to infection. The body may have experienced viral illness or bacterial illness. The viral illness always lasts between 2 to 3 days and is not always a reflection of serious illness. A sore throat in preschoolers like Jenifer is most likely caused by viral infection of the thoughts. No specific medicine is required to treat these symptoms, and the child should be better between seven to ten days.
Scenario 2: Allergic contact Dermatitis
The Disorder depicted in the scenario of the 27-year-old Man is that of allergic dermatitis. Dermatitis is localized inflammation of the skin. The irritant contact dermatitis is the inflammation that is caused when some substance found in the workplace come into direct contact with the skin. The common signs will include blisters, redness of the skin, and scales. These symptoms will not occur at the same time but will depend on the person’s skins and the type of the chemicals. The symptoms reported by Jack are the redness and irritation of the hands show that the dermatitis was caused by a chemical that irritates (Proksch & Brasch, 2012).
The adaptive response of the body to the localized injury tissues produce some of the signs of the inflammation include redness on the spot, swelling, pain, and heat. The contact dermatitis symptoms can develop shortly after handling short exposure, repeated or even prolonged but low exposure to the chemical substances. Jack in the scenario was exposed to mild irritant chemicals that caused the redness of skin and itchiness. However, continued exposure to the mild irritant chemicals will result in the appearance of small lesions and sores on the reddened area that will lead to formation of scales and crusts (Hamilton & de Gannes, 2011).
The irritant action of the abrasive substance is brought by the ability of the substance to change the properties of the skin and hence allow toxic substances to be exposed to the cells. The substance can also remove oil and moisture in the outer skin and hence reduce the protective ability of the skin. The removal of the fatty substance covering the outer skin results in the dryness and cracking of the skin. When the substance encounters the cells and body tissue, the endogenous present in the cells will react with the foreign substance which product skin damage (Hamilton & de Gannes, 2011). The body first reacts to foreign elements by developing localized acute inflammation when the cells and tissues try to develop a defensive response to the invading materials. The defensive response of the tissues is what causes the pain, redness, warmth, irritation, and swelling. Some of the factors that contribute to the severity of the irritant contact dermatitis include the properties in the chemical substance one is exposed to, the amount of concentration that has been exposed to the skin and frequency or length of the exposure.
Scenario 3: Depression
The disorder that is identified in the third scenario is a clinical depression. This scenario of the 65-year-old lady that is recently retired from work is an indication of depression. Depression is caused by many factors and combination of issues. According to Morey, Shea, Markowitz, Stout, Hopwood, Gunderson & Skodol, (2014) some of the common cause includes a long term or sudden illness like cancer or diabetes. Depression may also be caused by taking some medicines that cause depressive symptoms as a side effect. The disorder is caused by family genetics and hence the children of depressed parents are likely to be depressed at one point in their lives. Depression can also be caused by life events like divorce, death of loved one and money problems. It has also been established that certain personalities like people with low self-esteem are vulnerable to depression. To Martha, the depression must have been triggered by the increased burden of taking care of her 87-year-old mother that has difficulty recovering from broken hips. These circumstances were not expected after her retirement from work.
The adaptive responses to depression include difficulty in sleeping and lack of interest in life. People will respond to disappoints in life through sadness and grief, but it can turn ton depression when it lingers or become severe. The signs of depression include insomnia, anorexia, and some common tiredness. Depression is often not diagnosed in the elderly person as they can be easily dismissed as part of aging or acceptable response to stress (Iaboni & Flint, 2013). Depression in the elderly may start by a person feeling low and empty and lacking interest in participating in daily activities. The person in the scenario has difficulty carrying out the daily activities, sleeping, eating, and enjoying life. The depression in Martha can be treated through three types of treatment that include psychotherapy, prescription of medication, and use of biological treatment.
Mind Map of Allergic Contact Dermatitis
The mind map is a diagram that shows the nurse or concerned physiologist all the concept around the diagnosis of a given disorder. The mind map for Allergic contact Dermatitis will, therefore, show maps that can be used to classify the ideas, support the studies, and organize the decision making process (Zimbron, 2008).
The mind map for Allergic contact Dermatitis is a picture that provides prognosis, complications, diagnosis, clinical presentation, etiology, epidemiology, pathophysiology, and Risk factors.
The prognosis occurs when the person can avoid the irritant substance. However, the complication is brought by the secondary neurodermatitis. The diagnosis does not require any specific test, hence the Allergic contact Dermatitis is diagnosed by clinical examinations. The clinical presentations that can be observed include redness, cracking of the skin, Dryness, Inflammation, and thickening. Contamination will take place when a person’s skin is exposed to chemicals or detergents that cause the skins to be red and irritated. The exposure to abrasive substance also makes the skin itchy, red, and inflamed (Zimbron, 2008).
The Etiology for the Allergic contact Dermatitis is that it is caused by common cutaneous irritants. The causes include mechanical irritants, microtrauma like fiberglass, and other solvents like organic solvents like alcohol turpentine, hair products, ketones, chlorinated, paints and acids. Other chemicals that can cause Allergic contact Dermatitis include soap, soda, and detergents (Zimbron, 2008).
The epidemiology part of the mind map includes occupational hazards, prevalence, and Environmental factors. The environmental hazards can include repeated exposure of the skins to the irritant or repeated washing of the hands with abrasive detergents. The prevalence of Allergic contact Dermatitis is 69.7% of the most highly exposed workers and 55.6% can lead to intensive care units (Zimbron, 2008).
The pathophysiology involves three processes of skin barrier disruptions, Epidural cellular changes, and release of Cytokin and T-lymphocytes. The adaptive responses to the alteration in the skin and cells include hardening of the skin to local expression of multiple cytokines. The irritation is caused by relatively thick layers of stratum granulosum.
The adaptive responses of the body to particular diseases, virus, and injuries can be used to identify the specific agents, virus, or bacteria causing the body discomfort. The adaptive responses will often be triggered when the infection or agents escapes the innate body defense mechanism and hence generating antigen. The adaptive response to depression includes insomnia, anorexia that was observed in the lady. The adaptive response to chemical substance includes redness, swelling, and itchiness. On the other hand, the symptoms expressed in the two year old are adaptive response of viral and bacterial infection that causes Throat infections.
Bathala, S., & Eccles, R. (2013). A review on the mechanism of a sore throat in tonsillitis. The Journal of Laryngology & Otology, 127(03), 227-232.
Hamilton, T., & de Gannes, G. C. (2011). Allergic contact dermatitis to preservatives and fragrances in cosmetics. Dermatitis, 14, 16.
Iaboni, A., & Flint, A. J. (2013). The complex interplay of depression and falls in older adults: a clinical review. The American Journal of Geriatric Psychiatry, 21(5), 484-492.
Morey, L. C., Shea, M. T., Markowitz, J. C., Stout, R. L., Hopwood, C. J., Gunderson, J. G., … & Skodol, A. E. (2014). State effects of major depression on the assessment of personality and personality disorder. The American journal of psychiatry.
Oomen, K. P., Modi, V. K., & Stewart, M. G. (2012). Evidence-based practice: pediatric tonsillectomy. Otolaryngologic Clinics of North America, 45(5), 1071-1081.
Proksch, E., & Brasch, J. (2012). The abnormal epidermal barrier in the pathogenesis of contact dermatitis. Clinics in Dermatology, 30(3), 335-344.
Zimbron, J., (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://www.medmaps.co.uk/beta/
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