NR507 Week 1 Case Study

NR507 Week 1 Case Study – Step-by-Step Guide

The first step before starting to write the NR507 Week 1 Case Study, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NR507 Week 1 Case Study

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NR507 Week 1 Case Study

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NR507 Week 1 Case Study

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NR507 Week 1 Case Study

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NR507 Week 1 Case Study

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NR507 Week 1 Case Study

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NR507 Week 1 Case Study Instructions

Purpose

The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with Allergic Rhinitis. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template. Have a look at NR507 Week 1 Discussion: Client Scenario.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

1. Analyze the case to arrive at the type of hypersensitivity reaction that the patient is exhibiting. (CO1)
2. Explain the pathophysiology of the identified hypersensitivity reaction. (CO1)
3. Identify all subjective and objective information provided in the case. (CO3)
4. Explain, using pathophysiology, the rationale for each subjective and objective finding. (CO1, CO3)
5. Identify two types of medications that are strongly recommended for the treatment of allergic rhinitis according to the clinical practice guidelines on the management of allergic rhinitis. (CO2, CO5)
6. Explain the mechanism of action of the two medication classifications and include how the symptoms of allergic rhinitis are alleviated when taken. (CO2, CO5)

Week 1 Case Study template

Pathophysiology & Clinical Findings of the Disease

1. Identify the correct hypersensitivity reaction:

• Explain the pathophysiology associated with the chosen hypersensitivity reaction:

• Identify at least three subjective findings from the case:

• Identify at least three objective findings from the case:

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1. Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each:

• Describe the mechanism of action for each of the medication classes identified above:

• Identify two treatment options that are NOT recommended (I.e., recommended against):

References

[Must be on a separate page and in APA format]

Requirements:

Content Criteria:

1. Read the case study listed below.
2. Refer to the rubric for grading requirements.
3. Utilizing the Week 1 Case Study Template, provide your responses to the case study questions listed below.
4. You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
5. You must use the Clinical Practice Guideline (CPG) for the management of allergic rhinitis to answer the treatment recommendation questions. The guideline can be found at the following web address: https://journals.sagepub.com/doi/10.1177/0194599814561600.You may also use a medication administration reference such as Epocrates to provide medication names.
6. Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

A 35-year-old woman presents to the primary care office with a history of nasal congestion that has worsened over time and recurrent sinus infections. She considered herself healthy until about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness that “seems to never go away”. She noticed that her rhinorrhea greatly improved when she attended her family reunion on a two-week Caribbean cruise but returned after being home a few days. She lives with her husband and 5- year-old child. They have two household pets: a dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago. Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema, allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and inflamed nares.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1. Identify the correct hypersensitivity reaction.
2. Explain the pathophysiology associated with the chosen hypersensitivity reaction.
3. Identify at least three subjective findings from the case.
4. Identify at least three objective findings from the case.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1. Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.
2. Describe the mechanism of action for each of the medication classes identified above.
3. Identify two treatment options that are NOT recommended (I.e., recommended against).

NR507 Week 1 Case Study Example

Pathophysiology & Clinical Findings of the Disease

1. Identify the correct hypersensitivity reaction:

The most appropriate diagnosis for the patient is allergic rhinitis (AR), a type I hypersensitivity reaction related to her environment. The patient reported a history of nasal secretion, sneezing, and nasal congestion for the last 12 months, which she claims have persisted. To make a diagnosis of AR, a comprehensive history can be taken from the patient, a thorough physical examination conducted with special focus on the HEENT (head, eyes, ears, neck, and throat), and other laboratory tests can be performed to confirm the diagnosis.

Patients will report symptoms that persist throughout the year, particularly in a specific environment, or symptoms that are noticed only during a particular season. From historical records, environmental factors that promote AR may include pollen from various sources, such as trees and grass, dust mites, and dander from animals. The latter are responsible for perennial allergens, which are present throughout the year.

To diagnose AR, various diagnostic tests can be conducted. Nasal smears depict large numbers of eosinophils. Skin tests can help determine specific allergens, including prick, scratch, and intradermal tests (Akhouri & House, 2023). Other tests include the Radioallergosorbent (RAST) and nasal provocation tests (Akhouri & House, 2023). Upon initiating medications such as oral antihistamines in patients with AR, they respond positively, and this can also be a modality of confirming the diagnosis.

• Explain the pathophysiology associated with the chosen hypersensitivity reaction:

AR is an IgE-mediated immunological response that develops following exposure to allergens (Liva et al., 2021). It is characterized by a watery discharge from the nose, sneezing, nasal obstruction, and itchiness of the nose (Akhouri & House, 2023). Upon inhalation of allergens, the immune system of individuals with a genetic predisposition produces specific IgE antibodies. The antibodies secreted become fixed to basophils found in blood or mast cells within tissues using their Fc ends.

Upon the next exposure to allergens, the antigen will bind to the IgE antibodies at their Fab ends. This reaction triggers mast cell degranulation, leading to the release of chemical mediators, including histamine. The inflammatory mediators produced are responsible for the symptomatic presentation of AR (Akhouri & House, 2023). Depending on tissue involvement, effects include vasodilatation, eosinophil infiltration, mucosal edema, excessive nasal gland secretion, or contraction of smooth muscles.

Clinically, the response to AR among affected individuals occurs in two phases: an early phase and a late phase (Akhouri & House, 2023). In the acute or early phase, the reaction occurs immediately, within 5-30 minutes after allergen exposure, and IgE production binds to mast cells, resulting in their degranulation. Histamine and leukotriene release cause local inflammation. The action of histamine on the trigeminal nerve causes sneezing and mucus production upon acting on the mucous glands. Other features include bronchospasm resulting from the release of vasoactive amines (Akhouri & House, 2023).

The late phase/delayed response occurs after 2-8 hours of allergen exposure. The mast cells produce interleukins 4 and 13, which cause cellular infiltration, including eosinophils, neutrophils, monocytes, basophils, and CD4+ T cells, into the mucosal tissues (Akhouri & House, 2023). These cells infiltrate sites where antigens accumulate, resulting in nasal edema, congestion, and the production of a thick secretion. 

• Identify at least three subjective findings from the case:

The woman reported experiencing nasal stuffiness, sneezing, and rhinorrhea that have been persistent. She also reported recurrent nasal infections.

• Identify at least three objective findings from the case:

The features observed on the patient by the Nursing Practitioner upon examination include allergic shiners, erythematous and swollen conjunctivae, red and swollen eyelids, allergic creases, and inflamed nares. Objective findings are the features that can be obtained from physical examination, and they include allergic salute, allergic crease, edematous nasal mucosa, allergic shiners, and Dennie-Morgan lines.  The lateral crease on the nose (allergic crease) is a consequence of constant rubbing of the nose. Allergic shiners manifested as lower lid venous swelling are due to obstruction of lymphatic and venous drainage, chronic obstruction of the nose, and orbital edema.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1. Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each:

According to Seidman et al. (2015), as published in the Clinical Practice Guideline for Allergic Rhinitis, the first strong recommendation for treatment is the use of topical steroids. Clinicians should recommend the use of intranasal steroids among patients who have a clinical diagnosis of allergic rhinitis and whose symptoms of the condition are affecting their quality of life. The second strong recommendation is the use of oral antihistamines. Clinicians should advise patients with allergic rhinitis who primarily complain of sneezing and itching to use oral second-generation antihistamines or less sedating antihistamines (Seidman et al., 2015).  

• Describe the mechanism of action for each of the medication classes identified above:

Intranasal steroids act on genomic and non-genomic pathways like transactivation, histone medication, transrepression, and SRC kinase signaling in reducing the severity of allergic inflammation (Watts et al., 2019). Through the reduction of the influx of inflammatory cells into the nasal mucosa in response to allergic stimuli, characterized by fewer eosinophils, neutrophils, basophils, and monocyte cells, they limit the secretion of vasoactive amines and the causation of bronchial hyperresponsiveness (Watts et al., 2019).

They also antagonize the antigen-induced hyperresponsiveness of the nasal mucosa, thereby minimizing the reaction to the allergen and reducing symptoms of AR. The action of onset of intranasal steroids is within 3-5 hours following administration of the first dose; however, it may go up to 36 hours before patients report a positive response to therapy. Examples of intranasal steroids for AR include budesonide, fluticasone propionate, and beclomethasone dipropionate (Daley-Yates et al., 2021).

Oral antihistamines block the action of histamine at its receptor (H1 receptor). Antihistamine medications act on the H1 receptor, thereby stabilizing the receptor in an inactive conformation and mitigating the effects of histamine (Watts et al., 2019). Histamine is associated with lowering the high level of vascular permeability, which can cause the dissemination of fluid to distant body parts, where the fluid accumulates and causes vessel dilatation and swelling. By antagonizing histamine receptors, antihistamine medications prevent this. The onset of action of second-generation antihistamines in managing AR occurs within 12-24 hours (Watts et al., 2019). Examples of 2nd-generation antihistamines include cetirizine, loratadine, and fexofenadine (Kawauchi et al., 2019). Antihistamines are effective in controlling sneezing, itchiness, and rhinorrhea.    

• Identify two treatment options that are NOT recommended (I.e., recommended against):

According to the Clinical Practice Guideline for AR, it recommends against the following two interventions in the management of AR: imaging and oral leukotriene receptor antagonists (LTRA). For imaging, clinicians should not routinely conduct sinonasal imaging modalities on patients presenting with symptoms consistent with a diagnosis of AR (Seidman et al., 2015). For LTRAs, clinicians are advised against prescribing oral leukotriene receptor antagonists as the mainstay therapy intervention among patients with AR (Seidman et al., 2015).

References

Akhouri, S., & House, S. A. (2023). Allergic Rhinitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538186/#:~:text=Objectives%3A%201%20Identify%20the%20abnormal%20immune%20response%20in

Daley-Yates, P. T., Larenas-Linnemann, D., Bhargave, C., & Verma, M. (2021). Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index. Journal of Asthma and Allergy, Volume 14, 1093–1104. https://doi.org/10.2147/jaa.s321332

Kawauchi, H., Yanai, K., Wang, D.-Y., Itahashi, K., & Okubo, K. (2019). Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. International Journal of Molecular Sciences, 20(1), 213. https://doi.org/10.3390/ijms20010213

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of Clinical Medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. (Whit) W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., & Wilson, M. N. (2015). Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery, 152(1_suppl), S1–S43. https://doi.org/10.1177/0194599814561600

Watts, A. M., Cripps, A. W., West, N. P., & Cox, A. J. (2019). Modulation of allergic inflammation in the nasal mucosa of allergic rhinitis sufferers with topical pharmaceutical agents. Frontiers in Pharmacology, 10, 294. https://doi.org/10.3389/fphar.2019.00294