Nurses have to see numerous patients and observe a wide range of disease processes on a daily basis. Therefore, it is crucial for them to be able to distinguish between normal functions and conditions of the organism and deviations that may serve as indicators of serious underlying disorders. Adaptive responses are compensatory mechanisms that allow the body to provide an immediate response to changes that are happening to it in order to maintain homeostasis (Feige, Morimoto, & Polla, 2013). A nurse must be able to identify these signs, reactions, and symptoms and diagnose what condition might have caused them.
The paper at hand will discuss three case studies demonstrating the mechanisms of adaptive response. The major goal will be to identify the pathophysiology based on alterations and adaptive responses in the case of each patient. The paper will also include a mind-map for tonsillitis that would feature diagnosis, pathophysiology, epidemiology, risk factors, clinical presentation, and adaptive response of the body to the disease.
Scenario 1
In the first scenario, a two-year-old female, whose name is Jennifer, is brought in by her mother for evaluation with symptoms described as high temperature (up to 103.2 degrees Fahrenheit), fussiness, and decreased appetite. The patient was in good health before the past three days. The examination revealed the temperature of 102.8 degrees Fahrenheit, the respiratory rate of 24 beats per minute, the pulse of 128 beats per minute, a throat erythematous with 4+ swelling tonsils, and diffuse exudates, palpable anterior cervical nodes, and hot and dry skin. These symptoms allow diagnosing acute tonsillitis.
Tonsillitis is inflammation of the pharyngeal tonsils caused by viral or bacterial infections that may extend to lingual tonsils and adenoids. The disease may be complicated by numerous immunological factors. Viruses that most often cause tonsillitis include Epstein-Bar virus (EBV), adenovirus, herpes simplex virus, cytomegalovirus, other herpes viruses, and the measles virus. 15-30% of tonsillitis cases are caused by bacteria, the most common source being the group A beta-hemolytic Streptococcus pyrogens (GABHS) and methicillin-resistant Staphylococcus aureus (MRSA). The bacteria invade into the mucosa lining of the tonsils, which leads to inflammation as the major adaptive response of the epithelium (Bochner, Gangar, & Belamarich, 2017).
Other possible responses include sore throat, swollen tonsils with yellow or white patches on them, fever, tender lymph nodes, painful swallowing, headache, and bad breath. The majority of these symptoms are present in the given case. Moreover, although the disease may appear in patients belonging to all age groups, it is most frequently met in children from 2 to 15.
Possible complications associated with the condition include obstructive sleep apnea, peritonsillar abscess, difficult breathing, and tonsillar cellulitis. In case the condition is not addressed in due time, it can cause post-streptococcal glomerulonephritis or rheumatic fever (Bochner et al., 2017).
Scenario 2
The second scenario involves a 27-year-old male named Jack, who complains about the irritation and redness of his hands. The patient noticed the condition two weeks before addressing his doctor. Although Jack’s hands feel hot according to his self-report, he denies having any pain. The patient has no related cases in this medical history. Neither does he report any allergies. However, the patient connects the condition with his occupation.
Jack is a maintenance engineer in a newspaper building and has to work with chemicals and strong solvents on a daily basis. The patient does not usually wear gloves when having to deal with those fluids and claims that he always washes his hands after finishing the work. There were not treatment attempts. The most probable diagnosis is allergic contact dermatitis.
An allergic contact dermatitis is a widespread form of postponed or cell-mediated hypersensitivity of the skin connected with the interaction of its barrier function, neuronal responses, and reaction to irritants. As soon as an allergen comes in close contact with the skin, it is bound to a carrier protein that processes a sensitizing antigen. Dendritic cells are responsible for the process. After that, the antigen is carried to T cells, which later get sensitized to the antigen. This causes inflammation and other adaptive responses to dermatitis. They include swelling, itching vesicular lesions, and erythema in the place of contact with the allergen.
The condition might be caused by numerous chemicals, solvents, preservatives, etc. Basically, the reaction occurs when physical or chemical agents ruin the skin surface more rapidly than the tissue is able to restore its cells. The diagnosis must be made only when all other similar conditions are excluded. Sometimes dermatitis gets aggravated due to frequent contact with water (Johansen et al., 2015). For the patient to deal with inflammation, it is essential to stop using any chemicals that lead to the appearance of the problem. Since it is impossible in the given case, Jack can try applying anti-inflammation treatments such as ointments or lotions. If the allergic response persists, an antihistamine drug may help.
Scenario 3
The third scenario involves a 65-year-old female named Martha. According to the patient’s self-report, she is having troubling sleeping, loss of appetite, and rapid heart. The patient has a long history of hypertension, which has been controlled with hydrochlorothiazide. In addition to this, the patient has been subjected to considerable lifestyle changes due to the fact that her mother moved into her house and broke her hip, which required a lot of assistance on behalf of the daughter. Thus, it can be concluded that the patient is subjected to stress–the condition that leads to elevated secretion of cortisol and anti-inflammatory cytokines (glucocorticoids) from the hypothalamic-pituitary-adrenal axis.
Noxious stimuli (too much time and effort spent on caring about the patient’s mother, in the given case) make the body develop non-specific responses that can be manifested differently in different patients. The mechanism is called the general adaptation system and is meant to help the body cope with stress. Although manifestations can be rather different, they are still not chaotic and appear in stages.
At the first stage, reaction or alarm occurs. As a result, the nervous system is aroused, making the organism to mobilize all its defense systems. The second stage involves adaptation to stress or resistance to it. In other words, the patient either escapes from the problem or decides to fight against it. Finally, the third stage is one of exhaustion. If the stress continues for rather an extended period of time, it leads to a failure of the defense mechanisms and homeostasis (Boss, Bryant, & Mancini, 2016).
As a result, a lot of health problems can emerge. The stress response causes activation of the sympathetic nervous system and the substantial release of norepinephrine. Consequently, the adrenal gland starts to produce catecholamines. This is the major reason for the patient’s complaints about rapid heartbeat and uncontrollable blood pressure, which she successfully managed to control before.
The problem is that catecholamine inevitably affects the cardiovascular system, whereas epinephrine is capable of enhancing myocardial contractility (Feige et al., 2013). Since the organism of the patient has to react to stress, the adrenal cortex increases the secretion of glucocorticoid hormones since their role in the homeostasis of the CNS is crucial. This means that the patient’s cognitive abilities, mood, memory, and sleep largely depend on the level of these hormones.
It is hard to predict what coping mechanisms will be activated in each individual case. The reaction is determined by the perception of the stress factor. The problem with stress management is that responses can be not only adaptive but also maladaptive, which means that the patient can develop cigarette-, alcohol, or drug addiction.
References
Bochner, R. E., Gangar, M., & Belamarich, P. F. (2017). A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses. Pediatrics in Review, 38(2), 81-92.
Boss, P., Bryant, C. M., & Mancini, J. A. (2016). Family stress management: A contextual approach. Thousand Oaks, CA: Sage Publications.
Feige, U., Morimoto, R. I., & Polla, B. (2013). Stress-inducible cellular responses. Basel, Switzerland: Birkhäuser.
Johansen, J. D., Aalto‐Korte, K., Agner, T., Andersen, K. E., Bircher, A., Bruze, M.,… John, S. M. (2015). European Society of Contact Dermatitis guideline for diagnostic patch testing–recommendations on best practice. Contact Dermatitis, 73(4), 195-221.