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NURS 6501 Module 1 Assignment: Case Study Analysis

NURS 6501 Module 1 Assignment: Case Study Analysis

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Introduction

This study is based on the underlying condition of a 42-year-old patient who has been presenting in the emergency department with redness, swelling, and pain in his right calf. The patient history indicates that he had developed a cut with the string trimmer while working in the yard, and he has cleaned it with water from the garden hose. He also covered it with a large bandage. After a few days, he developed a high fever and reaches the ED for care. The patient needs immediate care, resulting in the development of adverse effects like organ dysfunction, etc. This study constitutes how the signs and symptoms developed, followed by the genes associated and the process of immunosuppression.

System Development

The patient had developed a wound infection which, if not managed, can result in septic disease. The wound constituted of germs and bacteria, and the patient had not cleaned this sufficiently. The bacteria grew under the damaged skin spreading to sensitive tissues present. As a result of the infection, the inflammatory response has stimulated, and inflammatory molecules are released. These inflammatory mediators like white blood cells (WBCs) further produce free radicals and enzymes, resulting in tissue damage and nerve damage.

Therefore, pain is generated, which is caused by the stimulation of pain receptors. The wound site develops a swelling due to the excess movement of white blood cells and fluid into the injured area. The infected tissues and nerves are put under extra pressure with the swelling and causing pain. The formation of wound clots is also an inflammatory response of the body, so the site becomes red (Stone, Basit & Burns, 2020).

During an infection, the body makes up an excess of inflammatory cells, which are the WBCs that work effectively to kill the bacteria. In addition, the increased production of white blood cells may affect the hypothalamus, which shifts the average body temperature upwards. It occurs as the bacteria releases pyrogens in the body, generating the immune response (Prajitha, Athira & Mohanan, 2018; Balli & Sharan, 2020).

Genes That Associated with The Development of The Disease

The genes that are associated with the development of the infection include IL4, IL10, and NRAMP1. As a result of the disease from the bacteria, the inflammatory response is generating by interleukins like IL6, etc. The interleukin genes of IL4 and IL10 producing cytokines induced to make the anti-inflammatory response, restoring the balance after the cytokines storm. The IL4 is present in the eosinophils, basophils, and Th2 cells. The IL10 plays a central role in the development of the anti-inflammatory response and maintaining homeostasis. Both the genes, IL4 and IL10, are pleiotropic. They are also known to produce inflammatory responses, but they recruit to produce anti-inflammatory cytokines when controlling hyper inflammation. The proteins produced by IL4 and IL10 directly suppress the role of Th1 cells (Nedelopoulou et al., 2020). The NRAMP1 gene produces the NRAMP1 protein, an integral membrane protein expressed in the lysosome activity inducing cells macrophages and monocytes. However, the NRAMP1 is also known to have pleiotropic effects and is the gene responsible for producing disease resistance and can lead to the development of immunosuppression (Known, Jo & Park, 2018).

NURS 6501 Module 1 Assignment: Case Study Analysis

The Process of Immunosuppression and The Effect It Has On The Body Systems

Patients who do not have the ability or have reduced capacity for fighting bacteria and other microorganisms in the body. A cytokine-mediated inflammatory response had seen during a sepsis infection resulting in a hyper-inflammatory phase (Cytokine storm) followed by the immunosuppressive phase. Sepsis infection had characterized by the excess production of cytokine-mediated inflammatory mediators. Some evidence also suggests that the body also generates anti-inflammatory compounds as the inflammatory mediators are extra.

Immunosuppression can be caused due to various reasons like an underlying disease, age, genetics, medication, and surgery. The infection of sepsis activates the apoptosis of cellular B and T cells which are immune cells. As the apoptotic cells induce the activation of the dendritic cells, they have an increased role in the anti-inflammatory response in sepsis. The apoptosis of T cells further induces the downregulation of the CD4+ and CD8+ cells. This process is known as autophagy and contributes to immunosuppression. As the body’s immune cells are hyperactive, the cells also become exhausted, which can cause immunosuppression (Ono et al., 2018).

Conclusion

The patient presented to the emergency department has developed a wound infection, and there was a need for immediate management. As a result of the condition, the patient developed signs of pain, inflammation, and high fever, indicating sepsis. Sepsis results in immunosuppression which has multiple mechanisms like apoptosis of the immune cells. The genes responsible for the development of sepsis include NRAMP1, IL4, and IL10. Therefore, understanding these aspects of sepsis will make infection management easier for the nurse and reduce further risk.

References

NURS 6501 Module 1 Assignment Case Study Analysis

NURS 6501 Module 1 Assignment Case Study Analysis

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS:NURS 6501 Module 1 Assignment: Case Study Analysis

Balli, S., & Sharan, S. (2020). Physiology, Fever (Hyperthermia). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK562334/

Kwon, H. K., Jo, W. R., & Park, H. J. (2018). Immune-enhancing activity of C. militaris fermented with Pediococcus pentosaceus (GRC-ON89A) in CY-induced immunosuppressed model. BMC complementary and alternative medicine18(1), 1-14. https://doi.org/10.1186/s12906-018-2133-9

Nedelkopoulou, N., Dhawan, A., Xinias, I., Gidaris, D., & Farmaki, E. (2020). Interleukin 10: the critical role of a pleiotropic cytokine in food allergy. Allergologia et immunopathologia. https://doi.org/10.1016/j.aller.2019.10.003

Ono, S., Tsujimoto, H., Hiraki, S., & Aosasa, S. (2018). Mechanisms of sepsis-induced immunosuppression and immunological modification therapies for sepsis. Annals of gastroenterological surgery2(5), 351–358. https://doi.org/10.1002/ags3.12194

Prajitha, N., Athira, S. S., & Mohanan, P. V. (2018). Pyrogens, a polypeptide produces fever by metabolic changes in hypothalamus: mechanisms and detections. Immunology letters204, 38-46. https://pubmed.ncbi.nlm.nih.gov/30336182/

Stone, W. L., Basit, H., & Burns, B. (2020). Pathology, inflammation. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534820/

The goal of this paper is to provide an explanation for the symptoms observed in the given case scenario. a 34-year-old Hispanic male with end-stage renal illness who required a kidney transplant from a cadaver donor due to the absence of a matching family member. Additionally, I will be finding genes that may be involved in the development of the disease, as well as the immunosuppressive process and its influence on the body. In this situation, the patient acquired symptoms as a result of possible adverse effects from the transplant process and medications supplied.
Presented Symptoms and Pathophysiology
The patient acquired symptoms as a result of the transplant procedure’s potential complications and the drugs supplied. According to evidence-based research, kidney transplantation is the most effective medical option for individuals with chronic end-stage renal illness since it is the most sought and cost-efficient way of renal replacement. Acute organ rejection occurred as a result of the recipient’s immunological response against the donor’s distinct MHC surface antigens. This frequently occurs within days to months of an organ donation. There is a potential that the patient experienced rejection following the transplant, resulting in renal failure, which led to the patient’s weight gain and decreased urine output (Kuan & Schwartz, 2021). Additionally, sensitivity of the body to the alien organ resulted in a rise in temperature and weariness.
The Identification of Disease-Associated Genes
The immune reaction of the patient to the surgery and drugs is dependent on several factors, including genetic makeup, which might result in symptoms such as oliguria, increased weight gain, fever, and weariness (McCance & Huether, 2019). rs25487 of the XRCC1 gene is one of the particular genes involved in the development of renal disease. The gene predisposes individuals to end-stage renal disease. Additionally, the GSTP1 gene is associated with the levels of C-reactive protein and ferritin. Individuals carrying the gene, Abd EL-Hassib et al. (2021), have an elevated risk of oxidative and carbonyl stress. C-reactive proteins levels are elevated in patients with end-stage renal disease, which are markers of increased inflammation. Additionally, they exhibit a high level of oxidative stress.
Conclusion
Immunosuppression impairs the body’s ability to mount an immunological response to infections (Benvenuto et al., 2018). This can be accomplished by decreasing the amount of T-helper cells, which recognize foreign things and activate other immune cells to combat the pathogen (Tielemans et al., 2019). Additionally, the impact can be created in bone marrow. Additionally, it decreases inflammation in the body and accompanying symptoms. However, it may be harmful to the body due to an increased vulnerability to infection (Brown et al., 2017).
Finally, because the human system is interrelated, when one organ is harmed, the others may suffer as well. In this situation, the patient experienced organ rejection, which could result in increased inflammation. Reduced urinary output was a sign of renal failure.

References
Abd EL-Hassib, D. M., Zidan, M. A., El Amawy, M. M., Hegazy, H. A., & Ameen, S. G. (2021). Polymorphism of XRCC1 Arg399Gln may predict for development of end-stage renal disease. A PCR confirmed case-control study. Meta Gene, 29, 100915. https://doi.org/10.1016/j.mgene.2021.100915
Benvenuto, L. J., Anderson, M. R., & Arcasoy, S. M. (2018). New frontiers in immunosuppression. Journal of Thoracic Disease, 10(5), 3141-3155. https://doi.org/10.21037/jtd.2018.04.79
Brown, S. A., Tyrer, F. C., Clarke, A. L., Lloyd-Davies, L. H., Stein, A. G., Tarrant, C., Burton, J. O., & Smith, A. C. (2017). Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy. Clinical Kidney Journal, 10(6), 788-796. https://doi.org/10.1093/ckj/sfx057
Kuan, K., & Schwartz, D. (2021). Educational case: Kidney transplant rejection. Academic Pathology, 8, 237428952110068. https://doi.org/10.1177/23742895211006832
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for
disease in adults and children (8th ed.).
Tielemans, M. M., Van Boekel, G. A., Van Gelder, T., Tjwa, E. T., & Hilbrands, L. B. (2019). Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients. Transplantation Reviews, 33(2), 55-63. https://doi.org/10.1016/j.trre.2018.11.001

The introducing symptoms of the patient in the given case are predictable with Wound disease. Symptoms like redness, swelling, torment, and fever of 100.6 0 F are demonstrative of wound disease, most likely with Staphylococci.

Why the patient presented with the symptoms described?

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An inappropriate wash of the wound directly: Not long after the injury, the patient washed distinctly with water from a garden

NURS 6501 Module 1 Assignment Case Study Analysis

NURS 6501 Module 1 Assignment Case Study Analysis

hose, however not with cleanser or germicide. Tainted water or hose could have filled in as a source of disease to the injury, and ill-advised washing could have prompted the endurance of the creature on the injury surface (Rizani, 2015).

Wound payable to string trimmer: Since the customer in the given case had an injury because of String trimmer, which could hold Staphylococcus aurous from soil or plant materials, it could be the source from which Staphylococcus aurous entered the injury.

Cover with large Band-Aid: Improper washing followed by covering with enormous band-aid could have caught the bacteria on the injury surface, which advanced to wound contamination. Since, Staphylococci are also present as skin flora, covering with bandage could have encouraged the development of bacteria on the injury and brought about disease

            Consequently, all the above components could have added to wound disease as obvious from the redness, growing, torment, chills. Fever is because of the immune reaction towards the disease (Grumezescu, 2018). It should be quickly treated with anti-toxins, which if in any case, can prompt inconveniences, for example, Toxic Shock disorder. NURS 6501 Module 1 Assignment: Case Study Analysis

Treatment

            The wound should be cleaned and appropriately dressed with care. Anti-microbial, for example, Penicillins or its subordinates. Vancomycin can be utilized if there should be an occurrence of obstruction or when the disease spreads.

References

Grumezescu, V. (2018). Treatment Strategies for Infected Wounds. Molecules, 23(9). doi:10.3390/molecules23092392

Rizani, N. (2015). Modern wound dressing for wound infection: an overview. Indonesian Journal of Tropical and Infectious Disease, 53-59. NURS 6501 Module 1 Assignment: Case Study Analysis
Week 2: Altered Physiology

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