respiratory system or HEENT system

Topic 4 DQ 1

Choose a medical condition from the respiratory system or HEENT system and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical condition can be followed. Include your references in APA style.

Sample student response 1

Pathophysiology of Tuberculosis

Tuberculosis is an infectious respiratory condition caused by Mycobacterium tuberculosis that mainly affects the lungs. Some of the common symptoms of the disease include productive cough, fever, weight loss, and malaise (Hunter, 2018). The infection usually occurs after inhalation of contaminated air particles having the TB causing bacteria. The bacteria then pass through the upper respiratory system and settles in the lungs, specifically in the subpleural airspaces of the middle or lower lobes (Wani, 2013).

After ingestion of the M. tuberculosis bacilli by the alveolar macrophages, the bacteria start its destruction of the host’s macrophage. As a reaction to the process, inflammatory cells start getting attracted to the area of infection leading to irritation of the alveoli and inflammation of the lungs (focal pneumonitis). Similarly, pleural effusion, more so in primary infection can occur due to delayed hypersensitivity reaction to mycobacteria (Hunter, 2018),

For patients without any immunity, the infection can migrate to other body organs, including the kidneys, meninges, the vertebra, to list few. If left untreated, rupture of a tuberculosis lesion can occur leading to empyema which increases the risk of fatality.

The most crucial patient education for patients with TB is to take medication as prescribed by the physician, failure to which, positive outcomes may not be realized and the risk of developing multidrug-resistant TB increases (Nathavitharana et al., 2019). It is also crucial for patients to keep their appointments with the physician. The infected patient should also avoid close proximity interactions, and respiratory hygiene should also be observed at all times.

References

Hunter R. L. (2018). The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity. Frontiers in Immunology, 9, 2108. https://doi.org/10.3389/fimmu.2018.02108

Nathavitharana, R. R., Lederer, P., Tierney, D. B., & Nardell, E. (2019). Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. The international journal of tuberculosis and lung disease: The Official Journal of the International Union against Tuberculosis and Lung Disease, 23(4), 396–404. https://doi.org/10.5588/ijtld.18.0276

Wani, R. L. S. (2013). Tuberculosis 2: Pathophysiology and microbiology of pulmonary tuberculosis. South Sudan Medical Journal, 6(1), 10-12.

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Sample student response 2

Pneumonia

Pneumonia is a common viral or bacterial lung infection that can range in severity. It is an infection and inflammation in the terminals airway and alveoli. Community-acquired pneumonia (CAP) is common in children and can lead to mortality, especially in developing countries. According to(McCance & Huether, 2018), the risk factors for CAP include “age younger than 2 years, overcrowded living conditions, winter season, recent antibiotic treatment, attendance at daycare centers, and passive smoke exposure. Nutritional status, age, and underlying disease process influence morbidity and mortality related to CAP”(p. 1216).

Viral pneumonia in general is more common in children than adults. This virus is spread through direct contact, droplet transmission, or aerosol exposure. It is often difficult to differentiate viral and bacterial pneumonia is the beginning. However, most of the time viral pneumonia clinically presents as a cough without a fever or increased white blood count. The other signs and symptoms of this include rhinorrhea, malaise, rales, rhonchi, or wheezing. Bacterial pneumonia includes a cough, fever, and increased white blood count.

The other signs and symptoms of this include pleuritic pain, increased respiratory rate, decreased breath sounds in area of consolidation. There are many different bacteria that can cause bacterial pneumonia, with the most common being streptococcus pneumoniae. The pathophysiology for viral pneumonia includes edema, increased mucus, and interstitial pneumonia. The pathophysiology of bacterial pneumonia includes inflammation of bronchial mucosa and alveolar exudate (McCance & Huether, 2018).

Education for patients includes prevention for getting and/or spreading pneumonia. This includes frequent hand hygiene, covering coughs and sneezes, staying home when feeling ill, and getting the pneumococcal vaccination if recommended. Further education for patients that have pneumonia includes resting, staying hydrated, and taking medication as prescribed by the health care provider.

Reference

McCance, K., & Huether, S. (2018). Pathophysiology: The biological basis for disease in adults and children (8th ed.). Mosby. ISBN-13: 9780323402811

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Topic 4 DQ 2

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

Sample student response 1

One of the first-line treatments for tuberculosis is Isoniazid. Isoniazid is an antituberculosis antibiotic used to treat ad prevent TB as a monotherapy or as part of combination therapy.  The drug acts by inhibiting the synthesis of mycolic acid. This in turn affects the formation of the mycobacterial cell wall, which produces the bactericidal effects> Similarly, the rug interferes with the synthesis of DNA, carbohydrates, lipids, and nicotinamide adenine dinucleotide (Timmins & Deretic, 2006).

The drug is likely to cause isoniazid hepatitis for patients who use alcohol. Other population groups that should be closely monitored when under the drug include patients with renal failure, patients above 35 years, women in minority populations who are in the post-partum period, and pregnant women. Taking transaminase values is necessary before starting the patient in Isoniazid therapy and frequently thereafter (Wang et al., 2016). In case the values exceed three times the upper limit, then the medication should be temporarily stopped for review before it is restarted.  

The likely side effects of the drug include nausea, upper stomach pain, loss of appetite, vision changes at times accompanied by pain behind the eyes, and sudden onset of weakness or feeling tired. Isoniazid can interact with foods that contain histamine. Isoniazid can also interact with paracetamol, anticonvulsants, benzodiazepines, and theophylline.The drug is contraindicated in patients with a history of severe hypersensitivity reactions, including drug-induced hepatitis (Metushi et al.,2016).

References

Metushi, I., Uetrecht, J., & Phillips, E. (2016). Mechanism of isoniazid-induced hepatotoxicity: then and now. British journal of clinical pharmacology, 81(6), 1030–1036. https://doi.org/10.1111/bcp.12885

Timmins, G. S., & Deretic, V. (2006). Mechanisms of action of isoniazid. Molecular Microbiology, 62(5), 1220–1227. https://doi.org/10.1111/j.1365-2958.2006.05467.x

Wang, P., Pradhan, K., Zhong, X. B., & Ma, X. (2016). Isoniazid metabolism and hepatotoxicity. Acta Pharmaceutica Sinica B, 6(5), 384-392.

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Sample student response 2

tiotropium

Anticholinergics are agents of first choice for the symptomatic treatment of patients with COPD. Tiotropium is a long-acting inhaled anticholinergic designed for once-daily bronchodilator treatment of COPD. Maintenance therapy with tiotropium has been shown to be effective in the treatment of chronic obstructive pulmonary disease. Tiotropium has been thoroughly researched in clinical trials and has been shown to slow the progression of obstructive pulmonary disease and its consequences. Brand names include: Inspiolto Respimat, Spiriva, Spiriva Respimat, Stiolto.

Tiotropium is an antagonist of muscarinic receptors M1 to M5 (Price et al., 2009). Inhibition of the M3 receptor in the smooth muscle of the lungs leads to relaxation of smooth muscle and bronchodilation (Price et al., 2009). Pharyngitis, bronchitis, sinusitis, dry mouth, cough, and headaches are among the most common side effects of tiotropium. Insomnia, cataract, blurred vision, epistaxis, rhinitis, laryngitis, dysphagia, gingivitis, chest pain and palpitations, joint swelling, abdominal pain, gastroesophageal reflux disease, paralytic ileus of the intestine, abnormal liver function test, dysuria, urinary retention, angioedema, dry skin, herpes zoster, and dehydration are some of the less common side effects (ZuWallack, A.R. & ZuWallack R.L., 2004).

In individuals with prostatic hyperplasia and bladder-neck blockage, tiotropium should be taken with caution because it can aggravate urine retention. Patients who are receiving tiotropium for COPD treatment should check in with their prescribing provider on a regular basis to assess side effects and the progression of their obstructive lung disease.

References

Price, D., Sharma, A., & Cerasoli, F. (2009). Biochemical properties, pharmacokinetics and pharmacological response of tiotropium in chronic obstructive pulmonary disease patients. Expert Opinion on Drug Metabolism & Toxicology, 5(4), 417-424.

ZuWallack, A. R., & ZuWallack, R. L. (2004). Tiotropium bromide, a new, once-daily inhaled anticholinergic bronchodilator for chronic-obstructive pulmonary disease. Expert Opinion on Pharmacotherapy, 5(8), 1827-1835.