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NR 507 Week 1 Case Study - Allergic Rhinitis

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Chamberlain College Of Nursing

Chamberlain NR 507 Week 1 Case Study - Allergic Rhinitis

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Week 1 Case Study: Allergic Rhinitis

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

1. Identify the correct hypersensitivity reaction.
2. Explain the pathophysiology associated with the chosen hypersensitivity
reaction.
3. Identify at least three subjective findings from the case.
4. Identify at least three objective findings from the case.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment
recommendations.

1. Identify two strongly recommended medication classes for the treatment of
the condition and provide an example (drug name) for each.
2. Describe the mechanism of action for each of the medication classes
identified above.
3. Identify two treatment options that are NOT recommended (I.e.,
recommended against).

Pathophysiology & Clinical Findings of the Disease

1. Identify the correct hypersensitivity reaction:

, Week 1 Case Study: Allergic Rhinitis

I believe this patient is having a Type I hypersensitivity reaction to her cat. This patient
has persistent clinical symptoms due to histamine release causing her rhinitis, rhinorrhea,
and edema of her eyelids and nares. This patient saw great improvement in symptoms
while away from home (and the cat) on a vacation and her symptoms returned shortly
after returning home (with the cat). The otherwise healthy patient began experiencing
these symptoms about 12 months ago, consistent with the time frame in which their
family welcomed a cat into their home, and they have persisted ever since.

2. Explain the pathophysiology associated with the chosen hypersensitivity reaction:
Type I hypersensitivities are IgE mediated, antigen-specific and mast cell inclusive
reactions. Common allergens, such as environmental, animal, and food, can provoke a
Type I allergy response as T-cells will signal to B-cells the production of IgE antibodies,
leading to the binding of Fc receptors on mast cells and basophils (McCance & Huether,
2019). Cross-linking of mast cells and basophils will result in the degranulation of the
cells and the release of histamine, and other inflammatory mediators such as
prostaglandins, and leukotrienes. These mediators increase vascular permeability,
vasodilation, rhinitis, and bronchoconstriction (Abbas, Moussa, & Akel, 2022).

3. Identify at least three subjective findings from the case:
-Nasal stuffiness
-Rhinorrhea
-Sneezing

4. Identify at least three objective findings from the case:
-Eyelid redness and swelling
-Conjunctival swelling and erythema
-Allergic shiner – lower lid venous swelling
-Allergic crease of nose
-Inflamed nares

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