NURS 6501 Week 2 Module 1 Assignment Case Study Analysis

NURS 6501 Week 2 Module 1 Assignment Case Study Analysis

NURS 6501 Week 2 Module 1 Assignment Case Study Analysis

Introduction: Scenario

The purpose of this paper is to explain the presenting symptoms in the assigned case scenario a 34-year old Hispanic male who has end-stage renal disease and needed a kidney transplant from a cadaver donor as there was no family member was a match. I will also be identifying the genes that may be associated with the development of the disease as well as the process of immunosuppression and its effect on the body. The patient in this scenario developed the symptoms because of the possible side effects of the transplant procedure and the medications administered.

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Symptoms Presented and the Pathophysiology

The patient developed symptoms because of the possible side effects of the transplant procedure and the medications administered.  According to evidence based research, Kidney transplantation has been proven to be the most effective therapeutic intervention medically in patients that have been diagnosed

with chronic end-stage renal disease because it is the most desired and cost-effective method of renal replacement. The recipient’s immune response against the differing MHC surface antigens of the donor resulted in acute organ rejection. NURS 6501 Week 2 Module 1 Assignment Case Study Analysis – This often happens days to months after an organ transplant.  There is the possibility that the patient developed transplant rejection leading to renal failure that contributed to the weight gain and the reduced urine output (Kuan &  Schwartz, 2021). Furthermore, the sensitization of the body to the foreign organ contributed to the rising of temperate and feeling fatigued.

The Identification of Genes Associated with the Disease:

The patients immune response to the procedure and medications is contingent upon certain factors such as  the genetic composition that can trigger symptoms like oliguria, incresed weight gain, fever and fatigue  (McCance & Huether, 2019). The specific genes that contributes to the development renal disease include rs25487 of the XRCC1. The gene makes people vulnerable to end-stage renal disease. Furthermore, the GSTP1 gene is also linked to the C-reactive protein and the ferritin levels. According to Abd EL-Hassib et al. (2021), individuals with the gene have increased risks for oxidative and carbonyl stress from the case study in NURS 6501 Week 2 Module 1 Assignment Case Study Analysis.  Patients with end-stage renal disease have increased levels of C-reactive proteins which are indicators of increased inflammation. Furthermore, they demonstrate a high oxidative stress level.

Conclusion

Immunosuppression reduces the ability of the body to activate the immune response to the pathogens (Benvenuto et al., 2018). The process may be achieved through the reduction in the number of T-helper cells which recognizes the foreign objects and activate other immune cells to fight the pathogen (Tielemans et al., 2019). Alternatively, the effect may also be induced in the bone marrow. Besides, it reduces the inflammation in the body and the associated symptoms. However, it could be detrimental to the body because of the increased susceptibility to infections (Brown et al., 2017).

Finally, the human system is interconnected, and thus when one organ has been affected the rest may also suffer. In this case, the patient suffered organ transplant rejection and this could lead to increased inflammation. Decreased urine output was an indication 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

Case Study

The case involves a 65 years old patient with obesity and experiences pain in the lower quadrant region.  Also, the patient has symptoms such as fever and constipation. He experienced multiple episodes of the signs and symptoms in the past 15 years; though, he has not received adequate treatment. Besides, the patient has always been using bowel rest and oral antibiotics to manage the condition. He refused to have the colonoscopy despite having a history of chronic inflammatory bowel disease, a sedentary lifestyle, and even consuming a diet lacking fiber. The patient has a family history of cancer; the grandfather died of cancer in the 1950s. Understanding such is essential in exploring the possibility of the patient having inherited the condition. The patient finally had a colonoscopy, and the findings indicated multiple polyps and adenocarcinoma of the colon. The purpose of this assignment is to analyze the genes, cells, and process elements involved in the patient’s case and outline their roles in the diagnosis and implications to the patient’s health.

Reasons for the Patient’s Presentation

Diverticulitis is a condition characterized by inflammation of the pouches in the intestine. According to Kamal et al. (2019), diverticulitis disease is common among older patients and affects the colon’s left side. Environmental factors and genetic predisposition influence the disease’s progression. Furthermore, the other causative factors for the disease include lack of fiber in the dietary intake and obesity. The complications associated with the condition include bleeding and perforation in the stomach linings. There are high chances that the patient had diverticulitis that contributed to the signs and symptoms. The inflammation in the diverticula results in painful experiences and fever. The condition can respond to antibiotics and hydration, which is why the patient had used the remedies for a long time to manage the disease. The other common signs and symptoms of diverticulitis include pain in the lower left part of the abdomen that tends to be episodic. The pain worsens after eating. Also, the patient is likely to have constipation or diarrhea with occasional blood in the stool.

Diverticulitis may either be symptomatic or asymptomatic. Most people with the condition may occur asymptomatic and unaware unless the condition is detected using colonoscopy imaging. However, the symptomatic cases are characterized by attacks in the iliac fossa. The condition can also co-exist with other diseases such as irritable bowel disease. The disease progression begins with obstruction in the diverticulum that results in intraluminal pressure, perforation, and abscesses. The patient experienced instances of constipation, which could be due to poor dietary intake.

Genetic Predisposition

Diverticulitis is a hereditary condition that commonly occurs among first-degree relatives. The specific genes involved in the condition include the TNFSF15 rs7848647, which is also associated with colon carcinoma. Besides, MLH1, MSH6, MSH2, and PMS2 are also linked with pathogenesis (Nasef & Mehta, 2020).

According to Nasef & Mehta (2020), the tumor necrosis factor superfamily member 15 is associated with an increased risk for inflammatory bowel diseases and diverticulitis. The study reports that the gene factor encodes the tumor necrosis factor ligand-related molecule 1, essential in mucosal immunity. The TNFSF15 is expressed in the endothelial cells. The TLIA is a splicing variant of the gene TNFS15 encoded by four exons (Nasef & Mehta, 2020). With the fourth exon and the adjacent intron that encodes the TL1. The TL1A is closely associated with the levels of inflammation in the course of IBD and diverticulitis. Also, their function triggers the T cell subtypes’ production, resulting in the elevated concentration of the interleukin 2 signalings. The study also explored the role of the TNFSF15 in inflammatory bowel diseases, and the findings indicated that the gene has a significant role in the inflammatory response in diverticulitis.

The MSH6 and MLH1 also have significant roles in the disease development and progression of the patient.  The study by Jun et al. (2019) indicates that MLH1 and MSH2 are tumor suppressor cells involved in repairing errors occurring during genetic replication. The mutations in the MLH1 and MSH2 are associated with the development of diverticulitis. On the other hand, the loss in the function in the mismatched repair genes, including the MLH1, MSH2, PMS1, MSH6, and the PMS2, results in the microsatellite instability that eventually causes diverticulitis (Jun et al., 2019).

The Process of Immunosuppression and Effect on Body System

Immunosuppression is the process through which the body’s immune response is weakened. The process results in the inability of the body to recognize antigens and influence the production of antibodies. The immune responses occur in many phases and depend on the pathogens involved. The natural barriers, complement system, and natural killer cells are the primary line of defense for many infections. The body recognizes the antigens presented to the macrophages through the antigen-presenting cells and then triggers the T-helper cells to produce other immune responses. Therefore, one of the ways through which immunosuppression occurs is through the reduction of the amount of T-helper cells produced; therefore, reducing the ability of the body to recognize the pathogens. The process can occur naturally due to chronic infections such as HIV/AIDs, obesity, and diabetes or through therapeutic intervention. One of the drugs used in reducing the immune system is cyclosporine, which reverses the inhibition of the immunocompetent lymphocytes in the G0 and G1 phases of cell division.

Immunosuppression has significant impacts on the body system. The cyclosporine also inhibits the production of lymphokines such as interleukin-2 and the T-cell growth factor that makes one more prone to infections. The body loses its ability to fight infections, and this could trigger the rising of opportunistic infections. Besides, reduced immunity means that an individual cannot respond accordingly to the pathogens, and this could lead to cell death. The continuous exposure to the pathogens also affect the body organ system. For example, people with prolonged COPD conditions could have compromised lungs and respiratory system functioning.

Conclusion

The patient in the case presents with diverticulitis and carcinoma in the colon. The signs and symptoms are consistent with the disease progression. The condition is genetically inheritable and is influenced by a series of genes, as indicated in this study. Finally, the human body has a natural immune response that protects the body from pathogens. Immunosuppression reduces the ability of the body to fight infection. The case helps in understanding how genetic factors play a role in disease development and progress. People with a family history of cancer are most likely to develop the disease in their lifetime, and this could explain the origin of the patient’s present condition, among other factors.

References

Jun, S., Park, E. S., Lee, J. J., Chang, H., Jung, E. S., Oh, Y., & Hong, S. (2019). Prognostic significance of Stromal and Intraepithelial tumor-infiltrating lymphocytes in small intestinal adenocarcinoma. American Journal of Clinical Pathology, 153(1), 105-118. https://doi.org/10.1093/ajcp/aqz136

Kamal, M. U., Baiomi, A., & Balar, B. (2019). Acute diverticulitis: A rare cause of abdominal pain. Gastroenterology Research, 12(4), 203-207. https://doi.org/10.14740/gr1166

Nasef, N. A., & Mehta, S. (2020). Role of inflammation in the pathophysiology of colonic disease: An update. International Journal of Molecular Sciences, 21(13), 4748. https://doi.org/10.3390/ijms21134748

Case Study Analysis

Cellulitis is a common bacterial skin infection that can spread rapidly if not promptly treated. The infection is primarily caused by Streptococcus and Staphylococcus bacteria (Chew, Kwek, Anicete, & Low, 2022)

. This case study analysis focuses on a 42-year-old male patient presenting with symptoms indicative of cellulitis. The aim is to elucidate the reasons behind the patient’s symptoms, discuss the microbiological elements associated with the disease, and explain the body’s inflammatory response and its systemic effects.

Scenario

A 42-year-old man presents at the clinic complaining of pain, redness, and swelling in his right calf. He reports that he was injured by a string trimmer while working in his yard. He cleaned the wound with garden hose water and covered it with a Band-Aid. Days later, he developed a fever and chills, noticed that his leg was swollen and red, and sought definitive care at the emergency department.

Explain why you think the patient presented the symptoms described

The patient’s symptoms of localized pain, redness, and swelling in conjunction with a fever and chills are indicative of a bacterial infection, likely cellulitis (Brown, 2023). The initial injury with the string trimmer, followed by potentially inadequate wound care, could have introduced bacteria into the skin, causing infection and subsequent inflammation (Long & Gottlieb, 2022).