Case Study
Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every spring and fall.

Physical Examination

• Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
• Skin: Flaking erythematous rash on the flexor surfaces of both arms
• Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)
• Lungs: Clear to auscultation and percussion

Response # 1: Carefully read the initial posts made by the other students in your small group.

• Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.

Peer Initial Post

Initial Post: Answer the following questions about Anna Sanchez and her condition. 

1. What evidence suggests that Anna does not have an acute severe infection? 

Anna’s vital signs are stable. the signs and symptoms of an acute severe infection are:  

• Fever and chills 
• Low temperature 
• Tachycardia 
• Nausea and vomiting 
• Diarrhea 
• Discolored or blotchy skin 
• Weakness and fatigue 

1. If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved? 

There are four (I-IV) types of hypersensitivity, these disorders are abnormal immune reactions that display various symptoms. Type I is immediate and intervened by Ige. The fourth type is a delayed reaction from direct contact. Anna appears to suffer from type I rhinitis which is an immediate hypersensitivity (Sobkowiak,et al.,2020).  

1. A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later? 

Allergies are the most common embellished response against an environmental antigen. After the anna’s initial contact with the cat, anna became sensitized and her B lymphocytes created antibodies that started to bind to the outer surface of the mast cells. Contact to the allergen before enough T cells or antibodies are present bring a hypersensitive response (McCance & Huether, 2018).  

1. What class of antibodies bind to the mast cells? 

Ige binds to crystalline fragments (FC) receptors on the surface of mast cells (McCance & Huether, 2018).  

1. What physiological mechanisms caused the redness of Anna’s nasal mucosa? 

Hypersensitivity that is irritated by exposure to a specific antigen.  When the allergen is introduced, it makes the mast cells release in the nose, when that release happens histamine is also released, which starts an inflammatory process (McCance & Huether, 2018).  

1. What mechanisms caused Anna’s clear postnasal drainage? 

Vasodilation and more porous surface due to the inflammatory mediators that were released by the mast cells caused fluid (mucus) build up and pool in the back of the throat and nose that drips down the throat (McCance & Huether, 2018).  

References 

McCance K., L., & Huether, S., E. (2018). 

Pathophysiology: The biologic basis for disease in adults and children

(8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473 

Sobkowiak, P., Langwiński, W., Nowakowska, J., Wojsyk-Banaszak, I., Szczepankiewicz, D., Jenerowicz, D., Wasilewska, E., Bręborowicz, A., & Szczepankiewicz, A. (2020). Neuroinflammatory Gene Expression Pattern Is Similar between Allergic Rhinitis and Atopic Dermatitis but Distinct from Atopic Asthma. BioMed Research International, 1–10.

https://doi-org.su.idm.oclc.org/10.1155/2020/7196981