As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Scenario 1:
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 weights 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. Compensatory Mechanisms Essay Case Study
Scenario 2:
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.
Scenario 3:
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.
To Prepare
Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
Review the examples of “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 constructing 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.
Review the Application Assignment Rubric found under Course Information
To Complete
Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:
For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.  Compensatory Mechanisms Essay Case Study

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Compensatory Mechanisms

Jennifer, the patient in the first case study presents symptoms associated with tonsillitis. Jennifer presents symptoms such as appetite loss, pain when swallowing, dry hot skin, erythematous, tympani, and also 4+ tonsils having diffuse exudates. The symptoms the patient is manifesting are the compensatory mechanisms by the body towards tonsillitis (Winch, 2013).

The pathophysiology the patient presents is very common in children in her age bracket. The bacterial or viral infection on the surface of the mucous membrane causing inflammation on the tonsils as the body responds to the infection (Winch, 2013). The inflammation of the tonsils is what leads to tonsillitis producing symptoms such as sore throat, swallowing difficulties, and swollen tonsils.

It is important to investigate the cause of infection (bacteria or virus) in order to prescribe specific treatments that will target the specific microbe. For this patient, it is clear that she has a bacterial infection that can be streptococci or staphylococci. Jennifer manifests painful swallowing and difficulties in swallowing which is caused by swelling of the lymph nodes and also due to the swollen tissue (Stelter, 2014).

The fever Jennifer manifests also is an attempt of the body to fight infection (Stelter, 2014). The objective data also shows that Jennifer has increased heartbeat and increased respiratory rate. This is also the body’s response mechanism to reduce the heat manifesting as fever.

The diagnosis for the second patient (Jack) is irritant contact dermatitis. The rationale for this diagnosis is due to the presenting symptoms such as skin redness and irritation on the hands (Nassiri-Kashani et al, 2016). In addition, the patient handles abrasive chemicals and solvents in his work, in addition to having to expose his hand to these solvents and chemicals without using any gloves.

The pathophysiology of irritant contact dermatitis starts when the skin comes in contact with abrasive irritants. Irritant contact dermatitis occurs due to the skin’s inflammation when it comes in contact with the irritants. As a response mechanism to the irritant and abrasive chemicals, cells of the skin release proinflammatory cytokines. The pathophysiological changes that occur in irritant contact dermatitis consist of the skin barrier becoming disrupted, the release of cytokine, and changes in the epidermal cells (McGuckin & John, 2016). When the skin is exposed to the chemicals and abrasives for a long time, they become cutaneous irritants.  Compensatory Mechanisms Essay Case Study

For Jack, the cutaneous irritation occurred when solvents in the chemicals removed essential fats and oils from the skin. This led to increased water loss on the transepidermal, making the skin more susceptible to harmful and toxic effects of the chemicals and abrasives, and thus resulting in irritation. Moreover, abrasive solvents irritate the skin and hence they cause irritant contact dermatitis (McGuckin & John, 2016).

The irritation on the skin after coming in contact with abrasive solvents and chemicals occurs when they change the properties of the outer layer of the skin that is normally a protective barrier. As earlier indicated, the changes also encompass loss of oil and moisture from the outer layer of the skin. When the oil is removed, the oil and moisture are removed, the irritants easily infiltrate the skin. These reactions lead to damage to the skin and the response mechanism from the body is acute localized inflammation. Tissues and cells attempt to repair the damage using a defensive response mechanism in order to eliminate the foreign substances that cause the damage. According to McGuckin & John (2016), the defensive response mechanism from the body produces symptoms such as irritation, pain, and skin redness, as manifested in this patient.

The third patient Martha presents symptoms of anxiety disorder. Anxiety disorder is typified by symptoms like sleep disturbances, loss of appetite, and a “racing heartbeat”. The patient manifests these symptoms and the symptoms are the body’s response mechanism to the anxiety resulting from her worries about the unexpected retirement and the responsibility of taking care of her mother (Bystritsky et al, 2013).

Specifically, the pathophysiology of anxiety in Martha started with excessive stimulation of the neurotransmitter glutamate, in addition to the elevated influx of calcium. Glutamate is a neurotransmitter that gets over-stimulated when a person has anxiety or stress causing symptoms such as sleep disturbances, worrying, increased heartbeat, and appetite loss (Bystritsky et al, 2013).

Mind Map for Tonsillitis

References

Bystritsky A, Sahib K, Cameron M & Jason S. (2013). Current Diagnosis and Treatment of Anxiety Disorders. P T. 38(1), 30-38, 41-44, 57.

Nassiri-Kashani M, Hassan M & Ghafari M. (2016). Evaluation of occupational allergic contact dermatitis and its related factors in Iran. Med J Islam Repub Iran. 30 (468).

McGuckin M & John G. (2016). Irritant Contact Dermatitis: A Survey of Healthcare Worker Knowledge, Perceptions and Actions. American Journal of Infection Control. 44(6), 22-32.

Stelter K. (2014). Tonsillitis and sore throat in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 13(7).

Winch S. (2013). Bacterial tonsillitis: prevalence, prediction and treatment by the ECP. Journal of Paramedic Practice. 2(9).  Compensatory Mechanisms Essay Case Study