NR 511: Differential Diagnosis and Primary Care

NR 511: Differential Diagnosis and Primary Care Transcript 1. Allergic Rhinitis Sara Martinez NR 511: Differential Diagnosis and Primary Care Chamberlain College of Nursing August 2018 2. Identify the disease condition and give a brief statement of incidence and prevalence in the U.S. Discuss the pathophysiology of the disease and typical clinical presentation seen in patients with the condition. *Allergic Rhinitis is the most common diseases in the US that effects adults and children alike it is the fifth most common here in the US alone. Alternate names such as hay fever or nasal allergies Occurring when allergen triggers the production of the antibody immunoglobulin E (IgE) , which binds to mast cells and basophils containing histamine is inhaled by an individual with a sensitized immune system Causing symptoms as sneezing, itchy and watery eyes, swelling and inflammation of the nasal passages and an increase in mucus production. Symptoms vary in severity between individuals It can also be defined as inflammation of the inside lining of the nose that occurs when a person inhales something he or she is allergic to, such as animal dander or pollen; examples of the symptoms of AR are sneezing, stuffy nose, runny nose, post nasal drip, and itchy nose. 3. Disease and background continued: How is allergic rhinitis classified well IgE mediated disease by as symptoms discussed earlier on the previous slide and also divided into classifications such as The temporal pattern of exposure to a triggering allergen, such as a seasonal (pollens) or perennial ( year around or episodic ( such as environmental eg, something exposed to when usually not around certain trigger) Seasonal allergic rhinitis (SAR) happening at the same time each year ( spring/Summer where pollen in the air) Perennial allergic rhinitis (PAR) every time in a year ( mainly caused by dust, animal allergen, fungi, cockroaches) Occupational allergic rhinitis related to occupation Severity of symptoms Frequency of symptoms Classification of Allergic Rhinitis helps the provider in choosing the appropriate treatment plan for the individual patient 4. Disease and background continued: As you can see by the chart allergic rhinitis is prevalent in 10%-20% of our US population with about 40 % are children and the mean age for this is 8-12 years of age. 30% -60% of all patients who come to the primary care setting 30%-60% 60 present with nasal symptoms *Allergic rhinitis is a worldwide health problem that affects adults and children. In the united states, allergic rhinitis is the 16th most common primary diagnosis for outpatient office visits. According to the National Health and Nutritional Examination Survey ( NHANES) in () 7398 People ages 6 years and older were surveyed for hay fever and current allergies along with current rhinitis and tested fir IgE specific to 19 inhalant allergens. 1 of every 3 reported rhinitis symptoms with in the last 12 months not associated with an upper respiratory infection. Meaning IgE- Mediated allergic rhinitis may affect 1 in 6 persons with in the United States . *Over an 8-year time period ending in 2002 the prevalence of Allergic Rhinitis has increased in children ages 13 to 14 years from 13 % to 19 % Disease and background continued: 5. Cost- it is estimated that an annual direct cost of allergic rhinitis ranges from 2 to 5 billion dollars and more than half of the cost of allergic rhinitis is most likely coming from prescription medications Quality of life- patients with co morbidities with allergic rhinitis are twice that amount. This can take a toll of the quality of life regarding cognitive function, decision making and self-perception in turn increasing days missed at work for adults. Productivity - this leads to productivity issues as stated for work loss in adults and an decrease in learning performance for children especially combined with common comorbidities such as sleep disorders or asthma 6. exposure to a variety of environmental aeroallergens leads to allergic sensitization, which is characterized by the production of specific IgE directed against these proteins. This process begins with the binding of the allergen by antigen-presenting cells, such as dendritic cells, in the nasal mucosa that process the captured allergen and present it to T cells. Ultimately, this may lead to the production of allergen-specific IgE, which binds to high-affinity IgE receptors present on the surface of mast cells in the nasal mucosa. 7. Identify the author, organization or group that developed the CPG along with the year of the original guideline publication. Discuss why the CPG is applicable in the primary care setting. Authors: Michael D. Seidman, writer, chair; Richard K. Gurgel, writer, assistant chair; Sandra Y. Lin, writer, assistant chair; Seth R. Schwartz, methodologist; Fuad M. Baroody, writer; James R. Bonner, writer; Douglas E. Dawson, writer; Mark S. Dykewicz, writer; Jesse M. Hackell, writer; Joseph K. Han, writer; Stacey L. Ishman, writer; Helene J. Krouse, writer; Sonya Malekzadeh, writer; James (Whit) W. Mims, writer; Folashade S. Omole, writer; William D. Reddy, writer; Dana V. Wallace, writer; Sandra A. Walsh, writer; Barbara E. Warren, writer; Meghan N. Wilson, writer; Lorraine C. Nnacheta, writer and AAO-HNSF staff liaison. Organization or Group American Academy of Otolaryngology- Head and Neck Surgery Foundation Year of guide lines : CPG applying it to the primary care settings : The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children younger than 2 years were excluded in this CPG because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a select number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to be an all-inclusive guide for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. The guideline is not intended to replace individualized patient care or clinical judgment. Its goal is to create a multidisciplinary guideline with a specific set of focused recommendations based on an established and transparent