Week 6 discussion question NR507 ALL SOLUTION 100% CORRECT SPRING -2022 LATEST GUARANTEED GRADE A+
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Course
NR 507 (NR507)
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Chamberlain College Of Nursing
A 12-year-old boy is brought to the office for evaluation of hives. He has no significant past medical history and no history of allergies. He has just joined the middle school soccer team and noticed that he gets hives about 10 minutes into practice. The hives are itchy and consist of irregular bl...
a 12 year old boy is brought to the office for evaluation of hives he has no significant past medical history and no history of allergies he has just joined t
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Week 6 discussion question NR507 ALL SOLUTION
100% CORRECT SPRING -2022 LATEST
GUARANTEED GRADE A+
A 12-year-old boy is brought to the office for evaluation of hives. He has no significant
past medical history and no history of allergies. He has just joined the middle school
soccer team and noticed that he gets hives about 10 minutes into practice. The hives
are itchy and consist of irregular blotches on his legs and trunk, about 10–20 cm in size,
and they persist for about 30 minutes. He does not experience swelling of the lips or
oropharynx and denies any wheezing or shortness of breath. His physical examination
is normal without skin lesions or oral swelling at that moment, and his lungs are clear.
After evaluation, he is diagnosed with urticaria.
1. Discuss the likely cause of the patient’s urticaria.
2. Describe the cellular mechanism of urticaria and how it leads to the signs and
symptoms experienced by the patient.
3. Describe the relationship between the patient’s symptoms and the concept of
inflammation.
4. What pharmacological and non-pharmacologic treatment options are available?
5. Discuss the complications of urticaria.
6. What teaching would be appropriate to provide the parent and child about
urticaria?
Support your response with at least one current evidence-based resource
1. Discuss the likely cause of the patient’s urticaria.
Allergic reactions can present with many different symptoms, some of which can be life
threatening. Urticaria, a skin reaction, is usually a type I allergic reaction and is characterized by
“wheals” or hives with surrounding red and edematous tissues (McCance & Huelther, 2019).
Urticaria is the most common skin reaction among children and can also be accompanied by
pruritis (Ben-Shoshan & Grattan, 2018). Not all urticaria is caused by an allergic reaction. The
most common cause of hives in children is due to infections followed by allergic reactions to
environmental antigens (Ben-Shoshan & Grattan, 2018). Upper respiratory infections and viral
infections are to blame for most viral or infectious cases of urticaria in children (Ben-Shoshan &
Grattan, 2018). Other causes of urticaria include medication reactions, certain foods, sunlight
exposure, and stress, however many cases of urticaria in children are idiopathic in nature (Shin &
Lee, 2017). Urticaria is classified into acute and chronic manifestations of the dermatitis (Shin &
Lee, 2017). Acute urticaria is typically short lived, lasting anywhere from four to twenty-four
hours. Chronic urticaria last for more than 6 weeks and is more often idiopathic. Both forms of
urticaria are hypersensitive immune responses (Shin & Lee, 2017).
, The most likely cause of the young soccer players urticaria is an allergic reaction to
something in the environment. As he is not complaining of any shortness of breath, and infection
symptoms are not noted in the available history, it is unlikely that the cause is viral or infection
related. The reaction could also be stress induced due to the new environment and pressures of
playing on a team, however due to the recurrent and specific time frame noted, this seems
unlikely. Without a medication history, it would be difficult to rule out medication reaction,
however this is also unlikely as the hives are recurrent and specific. Therefore, as he is new to
playing the game of soccer, he could be having a reaction to the pollen in the grass fields he is
playing on. He could also be having an allergic reaction to a weed killer, insect repellent or
fertilizer in the grass as well. Another possibility is that he is having a reaction to a dye or a
fabric cleaning agent in his new uniform.
2. Describe the cellular mechanism of urticaria and how it leads to the signs and
symptoms experienced by the patient.
The cellular mechanism that causes the symptoms of redness, swelling, itching, and
edema seen in urticaria are related to the release of histamine (McCance & Huelther, 2019).
When an antigen is detected, the body begins a cellular cascade that causes urticaria. Mast cells
that contain the allergen-specific IgE antibody release histamine, a chemical (Kasper et al.,
2019). These specific IgE-bound mast cells, release granulation and histamine but are able to
maintain viability. When degranulation occurs and histamine is released, capillary vasodilation
occurs and causes the blood and fluids to flow more freely. Once the vasodilation occurs, fluids
rich in proteins are then drawn into the superficial epidermal layers of the skin. This extracellular
fluid then pools under the skins surface causing the fluid filled papules and localized edema
(McPhee & Hammer, 2019).
3. Describe the relationship between the patient’s symptoms and the concept of
inflammation.
The symptoms of swelling, erythema and edema are significant when relating this case to
inflammation. Inflammation is an acute and non-specific immune response that begins with an
antigen (McCance & Huelther, 2019). The symptoms of inflammation are redness, heat, swelling
and pain, all of which can be seen in urticaria (McPhee & Hammer, 2019). Inflammation occurs
when mast cells release histamine that cause the capillary vessels to dilate. This creates the
redness and swelling at the site of the urticaria. Inflammation and the immune response are
intertwined and can be a noted causative factor in the redness and swelling seen in the wheals of
urticaria (McPhee & Hammer, 2019).
4. What pharmacological and non-pharmacologic treatment options are available
Non-pharmacological treatments for hives include removing the harm causing substance
as soon as possible (Godse et al., 2018). Maintaining hydration is important as well, therefore
increasing fluids is a non-pharmacological treatment option. Pharmacological treatment options
include oral antihistamines (Godse et al., 2018). Both first and second-line antihistamines can be
used, however, second-line use is becoming the standard of practice due to the benefits and
availability of these medications (Godse et al., 2018). Antihistamines such as desloratadine,
fexofenadine, levocetirizine, cetirizine, and loratadine are more common second-line
antihistamines, some of which are available over the counter. Corticosteroids may also be used to
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