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Scenario 2: A 65-year-old Patient with New Onset Atrial Fibrillation

Scenario 2: A 65-year-old Patient with New Onset Atrial Fibrillation

Scenario 2: A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF)

Scenario 3: 11-year-old boy complains of wheezing and difficulty “getting enough air.” Notices it more when he is playing baseball and symptoms improve when exercise activity stops. He says that the symptoms are getting worse and the symptoms are even occurring at rest. Mother says the child is allergic to cat dander and his next-door neighbor in their apartment building recently began sheltering cats for the local humane society. Auscultation demonstrates wheezes on forced expiration throughout all lung fields.

Scenario 4: 45-year-old woman presents with chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields.

 

Scenario 2 A 65-year-old Patient with New Onset Atrial Fibrillation

Scenario 2 A 65-year-old Patient with New Onset Atrial Fibrillation

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Why the Client Presented with the Symptoms

Aspergillus fungus causes invasive Aspergillosis. The patient presented with the symptoms because of the environmental exposure to the Aspergillus spp that causes Aspergillosis. Aspergillus spp. is present in environments such as soil. The client might have been exposed to the patient in his work environment or predisposed due to immunosuppression (Fosses Vuong & Waymack, 2021). The patient experienced fever due to the immune response to the infection. Accordingly, Aspergillus infection on the respiratory system stimulates the release of alveolar macrophages and neutrophils as the defense response, hence, fever. The immune response is also characterized by the release of inflammatory mediators such as leukotriene that lead to symptoms such as fever. The patient experienced fatigue and some chest pains with coughing due to the disease process such as phagocytosis. The activation of the conidia causes the loss of the protective layer of the respiratory system, which impairs gaseous exchange leading to fatigue. The chest pain with coughing was experienced due to the invasion of the lyphae of the infective microorganism on the endothelial cells. The invasion of the endothelial cells leads to thrombosis and endothelial damage, hence chest pains and hemoptysis. The hypoxia, invasion of the extracellular matrix, and inflammatory responses also lead to the development of the symptoms that the client presented with to the hospital (Challa, 2018).

Genes Associated with the Development of the Disease

The risk of developing invasive Aspergillosis is mainly attributable to the influence of genes. Accordingly, the risk of developing the disease is significantly elevated in carriers of IRF412203592T/T genotypes. The risk of the development of the disease is low in carriers of C allele. The prevalence of the development of the disease is moderate in the carriers of IRF4GGTC and IRF4AATC halotypes. In addition, the risk of developing the disease is elevated in individuals with IRFrs12203592 genes. The effect of genes that include cRel, NFkB1, RelB, and NFkB2 on the development of the infection is however low (Lupiañez et al., 2016). Therefore, there is an increased risk of the disease development in patients with specific genes.

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Process of Immunosuppression and Effects on the Body

Immunosuppression is the process in which the innate ability of the body to fight against infection and disease is lowered or suppressed. The suppression can be deliberate or due to a disease process. Deliberate immunosuppression is achievable with the administration of drugs such as rapamycin, azathioprine, cyclosporine and corticosteroids. The use of treatments such as irradiation in the cancer treatment may also lead to depression of the immune system. Irradiation may also be used in depressing the reactivity of the immune system in cases of bone marrow or organ allotransplant. Immunosuppression may also be due to the effect of a disease process. For example, patients affected by diseases that include acquired immune deficiency syndrome have suppressed immunity. The immunosuppression arises from the destruction of the CD4 cells by the HIV-1 virus. Immunologic tolerance may also lead to immunosuppression secondary to the role of antigen-induced reactions. The effects of immunosuppression on the body are the increased susceptibility to diseases and infections. The additional side effects of immunosuppression to the body include loss of appetite, fatigue, nausea, vomiting, and malignancy (Fattahi & Ward, 2017). Therefore, patients should be educated about the risk factors of immunosuppression, prevention and management to improve their lifestyle and behavioral decisions alongside use of medications.

Scenario 2: A 65-year-old Patient with New Onset Atrial Fibrillation

 

References

Challa, S. (2018). Pathogenesis and Pathology of Invasive Aspergillosis. Current Fungal Infection Reports, 12(1), 23–32. https://doi.org/10.1007/s12281-018-0310-4

Fattahi, F., & Ward, P. A. (2017). Understanding Immunosuppression after Sepsis. Immunity, 47(1), 3–5. https://doi.org/10.1016/j.immuni.2017.07.007

Fosses Vuong, M., & Waymack, J. R. (2021). Aspergillosis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482241/

Lupiañez, C. B., Villaescusa, M. T., Carvalho, A., Springer, J., Lackner, M., Sánchez-Maldonado, J. M., Canet, L. M., Cunha, C., Segura-Catena, J., Alcazar-Fuoli, L., Solano, C., Fianchi, L., Pagano, L., Potenza, L., Aguado, J. M., Luppi, M., Cuenca-Estrella, M., Lass-Flörl, C., Einsele, H., … Sainz, J. (2016). Common Genetic Polymorphisms within NFκB-Related Genes and the Risk of Developing Invasive Aspergillosis. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.01243

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