Sample Answer for ALTERATIONS IN CELLULAR PROCESSES NURS 6501 Included After Question
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
BY DAY 3 OF WEEK 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
A Sample Answer For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
In this week’s case study, the patient presents with a chief complaint of a sore throat and multiple other symptoms that resulted in a positive strep test. Strep throat, also known as bacterial pharyngitis, is caused by the presence of Streptococcus group A bacteria that is spread by respiratory droplets and is the most common cause of pharyngitis in children (Chauhan, et al., 2016). In a recent meta-analysis, 37% of children less than 18 years old were diagnosed with Group A Strep and presented to an outpatient center for treatment for a sore throat in comparison to only 15% of adults (Ashurst & Edgerley-Gibb, 2022).
The patient presented with a sore throat, reddened posterior pharynx with white exudate, and 3+ tonsils- all due to the presence and colonization of the streptococcus bacteria. The positive sign of anterior and posterior cervical adenopathy is due to the infection and the body’s response to try and fight the infection. The patient was prescribed ten days’ worth of amoxicillin and after consumption, immediately experienced swelling of the tongue and lips, difficulty breathing, and wheezing. The patient was having an anaphylaxis reaction to the antibiotics. An anaphylaxis response is IgE mediated and results in mast cells releasing a large amount of histamine and leukotrienes that cause bronchospasm and edema (Vaillant, Vashisht, & Zito, 2022).
Even after antibiotic treatment, some children get recurrent strep throat due to a genetic basis. A study performed by Dr. Shane Crotty and Dr. Jennifer Dan (2019), explored the germinal centers of both children with a normal rate of infection and those with recurrent tonsillitis. Their findings suggested that children with recurring strep throat had smaller germinal centers with fewer B and helper T cells which are responsible for producing antibodies and fighting invading pathogens. Upon further research, it was discovered that the genetic component was identified as two variants in the HLA genomic region which are associated with increased susceptibility to recurrent tonsillitis as well as protecting against the disease. If a child presented with recurring group A streptococcus pharyngitis, it may warrant a different response than treating with just antibiotics, such as referring them to an ENT for a tonsillectomy.
References
Ashurst, J. V., & Edgerley-Gibb, L. (2022). Streptococcal Pharyngitis. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525997/
Chauhan, S., Kashyap, N., Kanga, A., Thakur, K., Sood, A., & Chandel, L. (2016). Genetic diversity among group A streptococcus isolated from throats of healthy and symptomatic children. Journal of Tropical Pediatrics, 62(2), 152-157. doi:10.1093/tropej/fmv092
Crotty, S., & Dan, J. (2019). Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine, 11(478). doi:DOI: 10.1126/scitranslmed.aau3776
Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions. StatPearls. doi:https://www.ncbi.nlm.nih.gov/books/NBK513315/
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A Sample Answer 2 For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
In this scenario, an otherwise healthy 16-year-old boy is diagnosed with strep pharyngitis (strep throat) via an in-office rapid strep test, which tests for group A streptococcus bacteria (Cohen et al., 2016). He was prescribed penicillin, which is the antibiotic of choice for a patient with no known allergy to penicillin given that there is no strain of group A streptococcus bacteria that is resistant to it (“Centers for Disease Control,” 2022). Unfortunately for this young man, upon taking his first dose of penicillin he experienced an anaphylactic response, as evidenced by lip and oral swelling and breathing difficulties. This response is the most rapid and severe, and characteristic of a Type I hypersensitivity reaction, or IgE-mediated response resulting from the sensitization of mast cells by the binding of IgE to Fc protein receptors on the plasma membranes (McCance & Huether, 2019). Once sensitized, further exposure results in degranulation and release of histamine causing bronchial constriction and increased vascular permeability producing the breathing difficulties and lip and oral swelling respectively seen in this patient (Patterson & Stankewicz, 2020; McCance & Huether, 2019). Though type IV (IgG-mediated) hypersensitivity reactions are found in penicillin allergies, the primary result of this would be related to a delayed hypersensitivity mechanism resulting in dermatologic symptoms, not reported in this case (McCance & Huether, 2019).
Of note, Type I allergic responses can only occur with prior sensitization of the Fc proteins on mast cells. This patient was presented as having no known drug allergies, and while he could have taken penicillin in the past, which could have resulted in sensitization without evidence of allergic reaction, consideration should be given to the possibility that the patient carries a genetic erroneous beta (b)-lactam allergy. This could result in the allergic reaction without previously having taken the drug (Bhattacharya, 2010). Knowing the patient has a serious sensitivity to penicillins, the clinician should be aware of a cross-sensitivity to cephalosporins due to similarities in the chemical structure (Patterson & Stankewicz, 2020). Though research has shown females have a greater predisposition to penicillin allergy than males, the case presentation demonstrates a clear hypersensitivity reaction in this patient (Park et al., 2007).
References
Bhattacharya, S. (2010). The Facts About Penicillin Allergy: A Review. Journal of Advanced Pharmaceutical Technology and Research, 1(1), 11–17.
Centers for Disease Control and Prevention. (2022, June 27). Pharyngitis (strep throat): Information for clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#:~:text=Penicillin%20or%20amoxicillin%20is%20the,that%20is%20resistant%20to%20penicillin.
Cohen, J. F., Bertille, N., Cohen, R., & Chalumeau, M. (2016). Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd010502.pub2
McCance, K., & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Park, M. A., Matesic, D., Markus, P. J., & Li, J. T.-C. . (2007). Female sex as a risk factor for penicillin allergy. Annals of Allergy, Asthma & Immunology, 99(1), 54–58. https://doi.org/10.1016/s1081-1206(10)60621-7
Patterson, R. A., & Stankewicz, H. A. (2020). Penicillin Allergy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459320/
A Sample Answer 3 For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Great explanation of the type I hypersensitivity presented in this week’s case study. I was interested to learn about the genetic component and the possibility of the beta (b)-lactam allergy you spoke of and did not consider it when I was reviewing this patient. My assumption was that the patient likely took penicillin before making him hypersensitive to it now. Upon further research, I found an article that studied the prediction of penicillin allergy through genome mapping. This study researched 387 patients with immediate allergic reactions to B-lactams and found significant associations between gene variants HLA-DRA and an allergy to penicillin (Gueant, et al., 2015). It is important to note that this study confirmed predictors of penicillin allergies but not to cephalosporins. Although rare, it is interesting to understand that there could be a genetic component to those with allergies to penicillin. Another aspect to consider with this case study is how recurring strep throat could be a genetic component. Germinal centers of individuals with recurrent strep were found to be smaller, there were fewer B and helper T cells and two variants in the HLA genomic region could make them more susceptible to tonsillitis (Crotty & Dan, 2019).
References
Crotty, S., & Dan, J. (2019). Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine, 11(478). doi:DOI: 10.1126/scitranslmed.aau3776
Gueant, J.-L., Romano, A., Cornejo-Garci, J.-A., Oussalah, A., Chery, C., Blanca-Lopez, N., . . . Gaeta, F. (2015). HLA-DRA variants predict penicillin allergy in genome-wide fine-mapping genotyping. Journal of Allergy and Clinical Immunology, 135(1), 253-259. doi:https://doi.org/10.1016/j.jaci.2014.07.047
A Sample Answer 4 For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
The role genetics plays in the disease.
According to McCance (2019), humans have approximately 20,000-25,000 genes. An error in one of the genes can be the cause of an identifiable genetic disease (McCance et al., 2019). Variations in DNA and differences in how DNA functions on its own or in combination with the environment can be a contributing factors to disease processes (Jackson et al., 2018).
Why the patient is presenting with the specific symptoms described
The patient is presenting the symptoms of a reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. A rapid strep test performed in the office was positive. The patient has been infected either through a respiratory droplet or by direct contact with someone who had the disease. The symptoms the patient is presenting are from a bacteria called group A Streptococcus (group A strep). Among the symptoms presented by a patient infected by Streptococcus are Sore throat, fever, pain when swallowing, red and swollen tonsils, headache swollen lymph nodes.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The physiologic response to the stimulus in this case is the way the body reacted to amoxicillin 500 mg when the patient took it. The patient complained of difficulty breathing with audible wheezing. He had an allergic reaction to amoxicillin. This may have happened because the patient’s immune system became hypersensitive to the drug and mistook the drug as a harmful substance or as if the amoxicillin was a viral or bacterial infection. Seems the patient had never been exposed to the medication before
The cells that are involved in this process
The cells involved are Helper T-cells αβT cells. These cells can be divided into, CD4+ and CD8+ T cells. T cell-mediated immunity can be invoked upon recognition of foreign or non-self peptides (eg viral) presented by the human leukocyte antigen (HLA) molecules of an antigen-presenting cell (APC) (Goh et al, 2021). This was a type 1 hypersensitivity reaction.
How another characteristic (e.g., gender, genetics) would change your response?
Genetics would change my response by analyzing how immunodeficiency may affect this patient. Immunodeficiency emerges from the absence of elements of the immune system, such as the phagocytes, lymphocytes, and the complement system. These are classified as primary and secondary immunodeficiencies. The primary immunodeficiency cause deficiencies such as T-cell deficiency, B-cell deficiency, phagocyte deficiency, immunoglobulin A deficiency, and complement deficiency. The secondary immunodeficiency is caused by obesity, steroids, AIDS, nutrient deficiency, and viral infections. If this patient lacks the Helper T-cells due to immunodeficiency, this would be a life-or-death situation.
References:
Goh, SJR, Tuomisto, JEE, Purcell, AW, Mifsud, NA, Illing, PT. (2021). The complexity of T cell–mediated penicillin hypersensitivity reaction Allergy. 76: 150– 167. https://doi.org/10.1111/all.14355
Links to an external site.
Jackson M, Marks L, May GHW, Wilson JB. (2018). The genetic basis of disease. Biochem. ;62(5):643-723. doi: 10.1042/EBC20170053. Erratum in: Essays Biochem. 2020 Oct 8;64(4):681. PMID: 30509934; PMCID: PMC6279436.
McCance K. L. Huether S. E. Brashers V. L. & Rote N. S. (2019). Pathophysiology : the biologic basis for disease in adults and children (Eighth). Elsevier.
A Sample Answer 5 For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
, it is true that cells are the basic structural components of the body and are specialized to conduct different functions in the body. The central dogma also illustrates the pivotal role of genes in dictating the specialization of cells and subsequent events. Disease can alter the nature of cells thereby interfering with the normal cell functions. I find your case analysis quite intriguing, there are many patients who complain of sore throat that is related to allergic conditions and your analysis through genetic involvement is informative (Centers for Disease Control and Prevention,2021).
Group A streptococcus pharyngitis among children and adolescents is common and the identification of the genes associated with the common occurrence provides an avenue for solving the menace. Hypersensitivity relation to genetic composition also provides a better understanding of the recurrence of such cases (McCance & Huether, 2019). I also think that the bod defense system is triggered by recognition of the pathogen and the process of acting against the identified antigen leads to the symptoms, which include inflammation that would be felt as sore throat.
I agree hat the physiological processes upon identification of the antigen includes a variety of cells mediators that take part in the inflammatory pathway. These processes cause heat, swelling and redness. The patient characteristics that define different responses include age as age relates to immunity. Children are more susceptible to some diseases as compared to adults. Elderly people are also prone to some diseases that are not so common among young adults. Allergy to drugs also links to age as the allergy increases with age (Soderholm et al., 2018). I concur with you that severe allergic reaction would definitely be a concern
References
Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal
pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). Mosby/Elsevier.
Centers for Disease Control and Prevention. (2021, November 23). Pharyngitis (strep throat): Information for clinicians. Retrieved March 1, 2022, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
A Sample Answer 6 For the Assignment: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
Title: ALTERATIONS IN CELLULAR PROCESSES NURS 6501
This scenario provided describes a 16-year-old patient who presents with symptoms of streptococcal pharyngitis. Streptococcal pharyngitis is caused by Group A Streptococcus (GAS). The treatment for this gram-positive bacterium is typically amoxicillin or penicillin (Ashurst & Edgerley-Gibb, n.d.). The purpose of this discussion post is to examine the disease, symptomology, and cellular mechanisms of the scenario that was described involving the patient.
The Genetics Role
Studies indicate that there may be a genetic component that predisposes children to streptococcal pharyngitis. Anti-SpeA is anti-streptococcal pyrogenic exotoxin, an antibody that is specific to combating Group A Streptococcus. If a patient is Anti-SpeA deficient, they are more susceptible to contracting infections such as streptococcus pharyngitis (Dan et al, 2019). Soderholm et al state in their 2018 study that certain signaling components such as serine/threonine kinase IL-1 make patients less likely to contract infections such as streptococcus pharyngitis. If a patient is lacking these signaling components, they are more likely to contract infections.
Symptom Presentation
According to the scenario presented, the patient presented with a low grade fever, enlarged, reddened pharynx with white exudate, sore throat, and cervical adenopathy. GAS is typically transmitted through contact with secretions from and infected person. Once infected, the inflammatory response is activated by the presence of phagocytes and toxins in the blood. Swelling, pain, fever, and erythema are characteristics of the inflammatory response (McCance & Huether, 2019). Due to the inflammation of the pharynx, exudate is produced, containing neutrophils, leukocytes, and proteins. This is a part of the defense mechanism involved in removing the infectious virus.
The Physiologic Response
As previously stated, streptococcal pharyngitis is transmitted through contact with secretions from an infected person. The incubation period for streptococcal pharyngitis is 2-5 days. Once the bacteria enter the host, it attaches to epithelial cells and attacks the cells of the host, initiating the inflammatory response. The release of toxins into the system induces the symptoms the patient presented with including swelling, redness, pain, and fever.
The Cells Involved in this Process
There are many different cells involved in the inflammatory process. These cells include mast cells, neutrophils, macrophages, and cytokines. Mast cells induce inflammatory processes through mediator release. Neutrophils are involved with the ingestion of cellular debris, bacteria, and dead cells. Macrophages have several functions during the inflammatory response including chemotactic factors, wound repair, activation of the adaptive immune response. Cytokines bind to target cells to induce the synthesis of cellular products (McCance & Huether, 2019).
How Age Affects the Response
The age group most affected by streptococcal pharyngitis is children. As people age, they main gain immunity from streptococcal pharyngitis. Dan et al (2019) suggest that anti-SpeA antibodies in adults provide immunity against streptococcal pharyngitis. Therefore, the incidence of streptococcal pharyngitis is less likely to occur in adults than children. Age affects the likelihood that a patient will become infected with streptococcal pharyngitis.
References
Ashurst, J., & Edgerley-Gibb, L. (n.d.). Streptococcal pharyngitis – statpearls – NCBI bookshelf. Retrieved February 27, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK525997/
Dan, J. M., Havenar-Daughton, C., Kendric, K., Al-Kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, P., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam Arlehamn, C. S., Sette, A., Nizet, V., Bothwell, M., Brigger, M., & Crotty, S. (2019). Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science translational medicine, 11(478), eaau3776. https://doi.org/10.1126/scitranslmed.aau3776Links to an external site.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Innate Immunity: Inflammation and wound healing. (8th ed., pp 191-217). St. Louis, MO: Mosby/Elsevier.
Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal pharyngitis: Immune responses involved in bacterial clearance and GAS-associated immunopathologies. Journal of leukocyte biology, 103(2), 193–213. https://doi.org/10.1189/jlb.4MR0617-227RRLinks to an external site.
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