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NR507 WEEK1 DISCUSSION - CASE STUDY - JOHN 19YRS OLD MALE CC: SNEEZING, ITCHY EYES AND NASAL CONGESTION
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NR507 WEEK1 DISCUSSION - CASE STUDY - JOHN 19YRS OLD MALE CC: SNEEZING, ITCHY EYES AND NASAL CONGESTION
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NR507 WEEK1 DISCUSSION - CASE STUDY - JOHN 19YRS OLD MALE CC: SNEEZING, ITCHY EYES ANNASAL CONGESTION
Discussion Part One (graded)
John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal
congestion that worsens at night. He states that he has a history of asthma, eczema and
allergies to pollen. There is also one other person on the football team that has similar
symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F.
Write a differential of at least three (3) possible items from the most likely to less likely.
For each disease include information about the epidemiology, pathophysiology and
briefly argue why this disease fits the presentation and why it might not fit the
presentation.
John presented with a subjective symptoms of sneezing, itchy eyes, and
nasal congestion worsening at night. Also, he has a history of asthma,
allergies to pollen and eczema. His vital signs are within normal range,
except that he has an elevated temperature. His teammate has similar
symptoms. Based on the patient’s presentation and symptoms, allergic
rhinitis, common cold and sinusitis are the three differential diagnosis
possible.
1. Allergic Rhinitis
Epidemiology: Allergic Rhinitis (AR) often called allergies or hay fever is
a common health problem for which many patients do not seek proper
medical care. From various studies, 5-30% (approximately 60 million
Americans) of the population in the United States are estimated to have
the condition, particularly, but not exclusively, teenagers and young
adults (Maio et al., 2016). AR may begin to appear in patients as young as
2 years and usually reaches a peak in those aged 21-30 years. Symptoms
include sneezing, itching, nasal irritation, and rhinorrhea. The symptoms
occur when the patient breathes in allergens such as pollen, dust, food,
and pet dander. In childhood, allergic rhinitis affects more boys than in
girls, but in adulthood, men and women tend to be affected in fairly equal
proportions (Cazzoletti et al., 2015). While it is not a life threatening
condition, morbidity from the condition can be significant. AR is
associated with otitis media, allergic conjunctivitis, rhinosinusitis, atopic
dermatitis, nasal polyps and asthma. It may also contribute to learning
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, difficulties, impair quality of life, sleep disturbance and work
absenteeism.
Pathophysiology: Exposure to certain foreign proteins leads to allergic
sensitization. Allergic sensitization is characterized by the production of
specific IgE directed against these proteins. Produced antigen-specific IgE
binds to and prime mast cells and other inflammatory cells which are
present in the nasal mucosa. When the foreign protein is inhaled again
into the nose, it binds to the IgE on the mast cells leading to immediate
and delayed release of a number of mediators (Small, & Kim, 2011).
These mediators lead to the symptoms of rhinorrhea and sneezing as of
which develop in 30 minutes and disappears. The symptoms of delayed
release (4 to 8 hours after allergen exposure) are similar to those of the
early phase with less sneezing and itching but more congestion and
mucus production.
Argument: John is presented with 2 or more cardinal symptoms of
sneezing, itchy eyes, and nasal congestion; AR is strongly suspected.
There is a correlation between AR, asthma, and eczema as they are
atopic diseases with the same pathogenic base. One precedes the others,
or they often appear combined. John plays football so he is likely going to
be affected by grass allergens which is the most common allergen and he
is in the most common age group for allergies. However, there are
conditions with similar symptoms as AR. John has a low-grade fever,
which may be associated with the common cold. Fever is not a feature of
allergies. Also allergy is not contagious. One of John’s teammate has
similar symptoms. John might catch it from his teammate who might be
infected with the virus.
Rhinovirus (Common Cold)
Epidemiology: Rhinovirus often called common cold is a viral infection of
your nose and throat (upper respiratory tract). Common symptoms
include rhinorrhea, nasal congestion, sneezing, sore throat, cough,
headache, subjective fevers, and malaise. Colds are a frequent and
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