Assignment Instructions
The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with Allergic Rhinitis. Students will examine all aspects of the patient's assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Analyze the case to arrive at the type of hypersensitivity reaction that the patient is exhibiting. (CO1)
Explain the pathophysiology of the identified hypersensitivity reaction. (CO1)
Identify all subjective and objective information provided in the case. (CO3)
Explain, using pathophysiology, the rationale for each subjective and objective finding. (CO1, CO3)
Identify two types of medications that are strongly recommended for the treatment of allergic rhinitis according to the clinical practice guidelines on the management of allergic rhinitis. (CO2, CO5)
Explain the mechanism of action of the two medication classifications and include how the symptoms of allergic rhinitis are alleviated when taken. (CO2, CO5)
Case Study Scenario
A 35-year-old woman presents to the primary care office with a history of nasal congestion that has worsened over time and recurrent sinus infections. She considered herself healthy until about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness that "seems to never go away". She noticed that her rhinorrhea greatly improved when she attended her family reunion on a two-week Caribbean cruise but returned after being home a few days. She lives with her husband and 5- year-old child. They have two household pets: a dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago. Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema, allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and inflamed nares.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Identify the correct hypersensitivity reaction.
Explain the pathophysiology associated with the chosen hypersensitivity reaction.
Identify at least three subjective findings from the case.
Identify at least three objective findings from the case.
Sample Answer
Pathophysiology & Clinical Findings of the Disease
Identify the correct hypersensitivity reaction.
Type 1 hypersensitivity
Explain the pathophysiology associated with the chosen hypersensitivity reaction.
The patient is suffering from allergic rhinitis and which is a Type 1 hypersensitivity that is characterized by inflammation of the inside of the nose, especially the nasal mucosa. The patient considered herself healthy until 12 months ago when she started to experience nasal stuffiness, sneezing, and rhinorrhea. Her condition improved greatly when she attended a Caribbean cruise for two weeks. According to the information issued by the patient, it can be estimated that her allergy began at the same time that her family acquired a cat. Type 1 hypersensitivity is characterized by an immediate reaction that involves the release of antibodies against a soluble antigen mediated by the release of immunoglobulin E (IgE). On occurrence, the hypersensitivity results in the release of histamine and other inflammatory mediators as well as mast cell degranulation (Abbas et al., 2023). The inflammatory response is what leads to the symptoms of itching, sneezing, rhinorrhea, and inflammation around the nose and eyes that the patient is exhibiting.
Identify at least three subjective findings from the case.
Subjective findings refer to anecdotal information that emerges from the experiences and opinions of the patients. Some of the characteristics of subjective findings are; that they change with context, allow free expression, involve qualitative description, differ from one person to another, and describe how someone feels or looks (Faubion, 2024). The three subjective findings in the case study are sneezing, rhinorrhea, and improved symptoms when the patient was on a cruise ship and away from the cat.
Identify at least three objective findings from the case.
Objective data is the factual information that is gathered by healthcare professionals through measurement or observation. This information is true regardless of the opinions and feelings of the person presenting the information or the one receiving it. The major characteristics of objective data are that it is usually in the form of numerical details, it stays the same regardless of the circumstances and it allows concrete sharing of information (Faubion, 2024). The three objective findings in the case study are; allergic crease, allergic shiners, allergic shiners and conjunctival swelling.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.
For the treatment of allergic rhinitis, the CPG guidelines suggest the use of oral second-generation antihistamines and intranasal steroids. One example of intranasal steroids that would relieve the symptoms of rhinitis is Fluticasone (Flonase) which is a liquid nasal spray. Oral-second generation antihistamines such as Zyrtec (Cetrizine) or Claritin (Loratadine) can be used together with the nasal spray to relieve the symptoms exhibited by the patient.
Describe the mechanism of action for each of the medication classes identified above
Intranasal steroids yield vasoconstricting and inflammatory effects that decrease inflammation through the inhibition of macrophages, mast cells, and mediators such as leukotrienes. On the other hand, the oral-second generation antihistamines impede the release of histamine from mast cells in vitro (Sánchez & Castro, 2019). This type of medication possesses an H1-receptor activity that acts against the symptoms of rhinitis.
Identify two treatment options that are NOT recommended (I.e., recommended against).
According to the CPG guidelines, the use of oral leukotriene receptor antagonist or sinonasal imaging as the initial therapy is not recommended.
References
Abbas, M., Moussa, M., & Akel, H. (2023). Type I hypersensitivity reaction. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560561/
Faubion, D. (2024). Subjective VS. Objective Nursing Data: What’s The Difference. Nursingprocess.org. https://www.nursingprocess.org/subjective-vs-objective-nursing-data.html
Sánchez, G., & Castro, C. (2019). Prescription profile and clinical outcomes in patients with allergic rhinitis treated with oral antihistamines or nasal corticosteroids. International archives of otorhinolaryngology, 23(03), e325-e330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660288/