SophiaPretty
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Tracie L Willis
Walden University
NURS 6501: Advanced Pathophysiology
March 12, 2017
Week 2 Assignment
Adaptive Response
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Introduction
An adaptive response is a compensatory mechanism of the body’s appropriate reaction to an environmental demand (Adaptive response, 2017). As an Advance Practice Nurse, one must be able to recognize signs and symptoms that indicate an unbalance of the homeostasis of the body to correctly diagnose and treat a disorder. In this paper, I will discuss the pathophysiology, associated alterations, and the patients’ adaptive responses to the changes caused by the disease processes determined from the scenarios given for this assignment. Those disease processes are as follows; scenario 1) Tonsillitis, scenario 2) Contact Dermatitis, and scenario 3) Stress Response. I will also present a mind map of Tonsillitis that includes the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
Tonsillitis
In scenario 1, Jennifer, a two-year-old female, presents to the office with symptoms explained by her mother as a fever off and on for three days with a high-temperature today of 103.2° F, fussy, not able to eat, and in good health before the last three days. Physical examination shows a throat that is erythematous with 4+ swelling of her tonsils and diffuse exudate, hot and dry skin, palpable and tender to touch anterior cervical nodes. Jennifer states her throat “hurts a lot,” and it is painful to swallow. Her VS are a temperature of 102.8° F, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute. A diagnosis of Acute Tonsillitis is made, and treatment options are discussed.
Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation may extend to the adenoid and the lingual tonsils (Medscape, 2017). Tonsillitis is a result of viral or bacterial infections and other immunological factors that can lead to further complications of the disorder (Tonsillitis, 2016). Viruses are the cause of most cases of Tonsillitis, such as Herpes simplex virus, Epstein-Barr virus (EBV), Cytomegalovirus, Other herpes viruses, Adenovirus, and the Measles virus. When a determination of bacterial Tonsillitis is made, the group A beta-hemolytic Streptococcus pyrogens (GABHS) is the cause due to the bacteria adhering to the adhesion receptors located in the epithelium of the tonsils (Medscape, 2017). The invasion of these organisms into the mucosa lining of the tonsils creates an inflammatory response. This inflammation is one of the body’s adaptive responses to the disease process. Fever, swelling of the lymph nodes, erythema, and exudate are further adaptive responses to the disorder. Treatment options of tonsillitis with antibiotic therapy for bacterial tonsillitis, NSAIDs for pain and fever, rest and adequate fluid hydration, and Tonsillectomy in advanced or recurrent cases (Tonsillitis - Mayo Clinic, 2017). Complications involved with Tonsillitis present when Abscesses of the tonsils form and contribute to airway obstruction and sleep apnea (Huether & McCance, 2012).
Contact Dermatitis
In scenario 2, Jack, a 27-year-old male, presents to the office with symptoms occurring the last two weeks of red, flaky hands, denies pain or discomfort, but does state that his hands sometimes feel “a little hot.” Jack is a maintenance engineer and often works with harsh solvents and chemicals and due to a shortage, has not worn gloves as frequently as usual. A diagnosis of Irritant Contact Dermatitis is made, and treatment options are discussed.
Hammer & McPhee (2014) state that skin’s “most basic function is as a protective barrier against desiccation and disease by keeping moisture in and pathogens out.”(p. 187). The skin is one of the body’s first lines of defense. Irritant Contact Dermatitis is a non-immunologically mediated inflammatory response of the skin after contact is made with a chemical irritant. Contact with chemical irritants causes damage to the epidermal cells and inflammation. Inflammation is the second line of defense; presenting as redness, heat, swelling, pain, and sometimes loss of function (Huether & McCance, 2012). Adaptive responses of exposure to irritants are vasodilation, which will increase blood flow to the injured site, increased vascular permeability that delivers leukocytes, plasma proteins, and other biochemical mediators to the injury site (Huether & McCance, 2012, p. 121). The severity of the damage is directly related to the length of exposure and strength of the irritant. Treatment recommendations are for Jack to remove himself from contact with the irritant, treat symptoms with hypo-irritating cleansers and lotions and possible use of topical steroid cream to the hands (Huether & McCance, 2012).
Stress Response
In scenario 3, Martha, a 65-year-old female, presents to the office with complaints of insomnia, “racing heartbeat,” and a loss of appetite. Martha has HTN that is well controlled with medication and has been caring for her elderly mother for the last five years following her hip fracture and loss of mobility. A diagnosis is made of Stress Response. “Stress can be caused by significant life changes such as the loss of a job, loss of a family member, trauma, and abuse.” (Huether & McCance, 2012, p. 204). Martha retired from her job and had no social outlet to gain relief from the pressure of caring for her ailing mother. Stress begins “with a stimulus that the brain perceives as stressful and adaptation – and survival – related physiological response is promoted by the body.” (Huether & McCance, 2012, p. 204). During a study in 1946, Hans Seyle concluded that the body had a nonspecific response to noxious stimuli in a triad manifestation and named this response the general adaptation syndrome (GAS). These biological responses to stress occur in stages; 1) alarm stage or reaction, the central nervous system is aroused, and the body’s defenses are mobilized, 2) stage of resistance or adaptation, mobilizations contribute to flight or fight, and 3) stage of exhaustion, where continuous stress will cause the progressive breakdown of compensatory mechanisms and homeostasis (Huehter & McCance, 2012, p. 204). During the stress response, the sympathetic nervous system is activated, releasing norepinephrine which causes the medulla of the adrenal gland to release catecholamines into the bloodstream (Huether & McCance, 2012, p. 209). Physiological response to the release of catecholamine will affect the cardiovascular system, which is causing Martha’s previously controlled blood pressure to be uncontrollable. The release of epinephrine is enhancing myocardial contractility, causing Martha’s heart rate to increase as well as increasing her blood pressure. As a response to stress, an increase in secretion of glucocorticoid hormones by the adrenal cortex occurs. Glucocorticoids play and important role in the homeostasis of the CNS that regulates memory, cognition, mood and sleep (Huether & McCance, 2012). Stress Response presents differently from one person to the next based on a perception of the stressor and the coping mechanism of the individual. Coping is the compensatory mechanism for the process of managing stressful situations. Coping responses can be adaptive or maladaptive. Maladaptive coping can result in changes in behavior that can potentially be adverse to a person’s health such as drugs, alcohol, disturbances in the sleep-wake cycle, or smoking cigarettes (Huether & McCance, 2012). Adaptive coping strategies are those that focus on the problem and encourage social support resulting in the beneficial reduction in perceived stress. Possible treatment options for Martha are to promote socialization outside of caring for her mother, counseling, and support groups for people in similar situations.
Conclusion
In this paper, I discussed the pathophysiology, associated alterations, and the patients’ adaptive responses to the alterations caused by the disease processes determined from the scenarios given for this assignment. Those disease processes are as follows; scenario 1) Tonsillitis, scenario 2) Contact Dermatitis, and scenario 3) Stress Response. I also presented a mind map of Tonsillitis that included the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Understanding the pathophysiology of a disease and the body’s adaptive responses to the disease is imperative for the Advance Practice Nurse to diagnose and treat their patients accurately.
Tonsillitis Mind Map
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References
(Zimbron, 2008)
References:
Adaptive Response. (2017). TheFreeDictionary.com. Retrieved 10 March 2017, from http://medical-dictionary.thefreedictionary.com/adaptive+response
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
Medscape. (2017). Tonsillitis and Peritonsillar Abscess: Practice Essentials, Background, Pathophysiology and Etiology. (2017). Emedicine.medscape.com. Retrieved 11 March 2017, from http://emedicine.medscape.com/article/871977-overview
McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
Tonsillitis. (2016). American Academy of Otolaryngology Head and Neck Surgery Retrieved 10 March 2017, from http://www.entnet.org/content/tonsillitis
Tonsillitis - Mayo Clinic. (2017). Mayo Clinic. Retrieved 10 March 2017, from http://www.mayoclinic.org/diseases-conditions/tonsillitis/basics/causes/con-20023538
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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