Exploring Pathophysiology and Adaptive Responses in Three Medical Scenarios

The human body in many ways acts like the Newton’s 3rd law which is for every action, there is an equal and opposite reaction. When the body is going through changes, the body activates the compensatory mechanism. This is what is referred as adaptive response. Adaptive responses are changes in brain activity that are designed to maintain homeostasis and performance where possible (Fornito, Zalesky, & Bullmore, 2016). This paper will consider 3 separate medical scenarios to explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes.

Scenario 1

In this scenario, Jennifer who is a 2-year-old girl that is taken to a medical facility because she’s been running a temperature for the past 3 days and not getting better even though the mom has been giving her ibuprofen. Her body is hot and dry. The physical examination showed the throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. She also had a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Pathophysiology

Jennifer complained about her throat hurting and swollen tonsils. She was not coughing which is one of the reliable symptoms of sore throat. However, she exhibited erythematous throat with 4+ tonsils and diffuse exudates. Based on the symptoms of Jennifer, the diagnosis is likely to be tonsillitis. According Huether & McCance (2016), tonsillitis may be complicated by formation of a tonsillar abscess. Acute tonsillitis may be defined as inflammation of the tonsils, predominantly due to infection and it is part of the spectrum of pharyngitis that ranges from localized tonsillar infection to generalized infection of the pharynx. (Bartlett, Bola, & Williams, 2015)

Associated Alterations and Adaptive Response

Tonsillitis is an infection of the tonsils that affects millions of individuals each year. The alteration response for tonsillitis in the immune system is associated with the inflammation of the tonsils in response to invasion of the mucus membrane by viruses or bacteria.

Because of this alteration, symptoms such as fever, sore throat, pain associated with swallowing, exudate, increased respiratory and heart rate, and erythematous.

Scenario 2

27-year old Jack presented at the medical facility symptoms of redness and irritation on his hands. He mentioned that he noticed the skin being red and flaky about 2 weeks ago. He does not have any discomfort but does not know why they are so red. Jack does not have allergies and does not recollect being exposed to irritants even though he often works with abrasive solvents and chemicals. He has not been using gloves lately due to short supply. He always washes his hands when he is done handling the chemicals.

Pathophysiology

Irritant contact dermatitis is a nonspecific inflammatory dermatitis caused by activation of the innate immune system by proinflammatory properties of chemicals (Huether & McCance 2016). The acuteness of inflammation is directly related to the duration of exposure and how potent the chemical is.

Associated Alterations and Adaptive Response

According to Brasch, Becker, Aberer, et al., (2014), dermatitis reaction is an inflammatory intolerance response characterized by successive and coexistent erythema, blisters, exudation, papules, and flaking. This response pattern is caused primarily by toxins, that have an external, non-infectious, immunological, chemical, or physical effect, (Brasch, Becker, Aberer, et al., 2014). Jack mentioned he did not have allergies but has been handling abrasive solvent and chemicals without gloves regularly lately. Redness and itchy skin is the body’s response when the immune system reacts abnormally to foreign chemicals that are not safe.

Scenario 3

Martha who is a 65 year-old retired woman has a medical history of hypertension. She’s been able to control it over time with medication. She started having trouble sleeping, loss of appetite and feels like her heart is racing. The only change in her lifestyle is that her aging mother moved in with her. Her mother lost a lot of mobility and needed daily assistance with basic activities in life after she fell down on a flight of stairs. Martha does not mind caring for her mother because she is the only daughter but she was hoping for a much different and better retirement. She feels blessed because she sleeps and eats less given the conditions. However, she is worried about her health and wants to know why she is sleeping and eating less at her age.

Pathophysiology

Clearly in this scenario, Martha was a healthy woman and had great expectations of a wonderful retirement. The sudden occurrence of lack of sleep and appetite and the occasional racing heart beat only begun after her mother lost mobility and she had to provide round the clock assistance leaving her no time for herself to realize the vision of a great retirement life are the classic conditions associated with acute stress. According to Tsigos, Kyrou, Kassi, et al., (2016), stress is a state of threatened homeostasis caused by intrinsic or extrinsic adverse forces (stressors) and is counteracted by an intricate repertoire of physiologic and behavioral responses aiming to maintain/reestablish the optimal body equilibrium (eustasis).

Associated Alterations and Adaptive Response

The adaptive stress response depends upon a highly interconnected neuroendocrine, cellular and molecular infrastructure, and the stress system; however, adaptive response of each individual to stress is determined by a multiplicity of genetic, environmental and developmental factors, (Tsigos, Kyrou, Kassi, et al., 2016). Martha who is 65 year-old female is going through changes in her lifestyle that causes a lot of stress in her day-to-day life. With being the only child, primary care giver to her elderly mother, and no other support, Martha is exhibiting maladaptive coping, which has led to health problems in her life, including trouble sleeping, loss of appetite, and the racing heartbeat, which has had an adverse impact of her day-to-day life.

Conclusion

When patients present their symptoms to a healthcare provider or nurse practitioner (NP), a NP must take the time to listen, assess, diagnose, and treat the patient. Similarly to the scenarios above, an NP must be able to use the information given as well as information obtained from further testing to develop a plan of care, while also concerning themselves with the pathophysiological, alteration, and adaptive response methods. As with any diagnosis and treatment, unforeseen problems can arise, and the NP is responsible for analyzing and adapting to the circumstances in an effort to ease the minds of the patients while still providing the world class-care possible.

Reference:

1. Bartlett, A., Bola, S., & Williams, R. (2015). Acute tonsillitis and its complications: an overview. Royal Naval Medical Service 2015, Vol 101.1
2. Brasch, J., Becker, D., Aberer, W., Bircher, A., Kränke, B., Jung, K., … Schnuch, A. (2014). Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo journal international, 23(4), 126–138. doi:10.1007/s40629-014-0013-5
3. Fornito, A., Zalesky, A., & Bullmore, E. T. (2016). Fundamentals of Brain Network Analysis. St. Louis, MO: Elsevier.
4. Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St Louis, MO: Mosby.
5. Tsigos, C., Kyrou, I., Kassi, E., Chrousos, G. P., (2016. Stress, Endocrine Physiology, and Pathophysiology. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK278995/