Examines how the body responds to injury and infection by exploring the first, second, and third lines of defense.

nursing2APathophysiology

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Readings
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St.

Louis, MO: Mosby.
Chapter 5, “Innate Immunity: Inflammation and Wound Healing”

This chapter examines how the body responds to injury and infection by exploring the first, second, and

third lines of defense. It also covers wound healing and alterations of the wound healing process.
Chapter 6, “Adaptive Immunity”

This chapter examines the third line of defense, adaptive immunity. It also covers the roles of

antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B

and T lymphocytes in the immune response.
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Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has

been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no

significant medical history. She was in her usual state of good health until 3 days ago when she

started to get fussy, would not eat her breakfast, and would not sit still for her favorite television

cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF.

Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she

should come in for evaluation. A physical examination reveals a height and weight appropriate

2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are

slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with

4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to

touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow.

Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of

24 beats per minute.
Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he

has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed

to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit

hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that

he might have an allergy and he should get some steroid cream. Jack has no known allergies and no

significant medical history except for recurrent ear infections as a child. He denies any traumatic

injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits

that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but

lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to

some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was

finished.
Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a

local hospital. Her medical history is significant for hypertension, which has been controlled for

years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she

occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes

that she is not hungry like she used to be. The only significant change that has occurred lately in her

life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy,

but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has

lost a lot of mobility and independence and needs to rely on her daughter for assistance with

activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only

child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day,

and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother,

so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own

health though and wants to know why, at her age, she suddenly needs less sleep.


 

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