Soumi answered on
Mar 25 2020
Running Head: CASE STUDY 3 1
CASE STUDY 3 6
ASSESSMENT TASK 1 – CASE STUDY
(CHOSEN CASE STUDY = CASE STUDY 3)
Table of Contents
Pathophysiology of Acute Rheumatic Fever in Sue 3
Evaluating the role of the nurse in delivering suitable developmental nursing care for Sue 5
1. Developmental and Growth Theories 5
2. Family Centred Care 6
3. Effects of Hospitalisation of Sue on her and her Family 6
Pathophysiology of Acute Rheumatic Fever in Sue
In the cu
ent case study, Sue is a girl, aged 14 years, belonging to the Aboriginal population of Australia. She was diagnosed with Acute Rheumatic Fever (ARF). ARF is occu
ed to an individual due to being infected by Streptococcus pharyngitis (Strep bacteria). Even though its pathogenic mechanism is not completely understood, disease development occurs after 2 weeks of Strep infection. ARF manifestation occurs in patients with genetic susceptibility upon Strep infection, wherein immune cells get activated by presentation of S. pharyngitis antigens to T and B cells (Sika-Paotonu, Beaton, Raghu, Steer & Carapetis, 2017). Thus, production of particular IgM, IgG and activation of CD4+ T are initiated.
As structural similarity is found between Strep bacteria and the human, protein cross activations of antibodies transpire against human protein. This immune cross-reactivity leads to tissue injury followed by clinical symptoms such as rheumatic fever, carditis that occurs due to infiltration of T cells and antibody binding, transient arthritis by immune complexes formation, neurological disorder such as chorea develops by the binding of antibodies to basal ganglia in the
ain and some skin ailment by the effect of delayed hypersensitive reaction (Yacoub, Mayosi, ElGuindy, Carpentier & Yusuf, 2017).
Figure 1: Infection
(Source: Carapetis et al., 2016, 15084)
As discussed in Lewis rat model, there is a clear evidence of molecular mimicry seen in the development of carditis in patients with strep infection as both T and B cells cross reactivity triggers the immune responses. As stated by Carapetis et al. (2016), the tissue injury that takes place in rheumatic fever occurs due to the molecular mimicry, in which the T-cell and B-cell mediated immune responses of the patient are not able to discriminate between the host tissues and the attacking bacteria.
The antigenic structure of S. Pharyngitis contains helical protein with N-acetyl-beta-D-glucosamine that shared the epitope with myosin. Further, it is also seen that antibodies against both these proteins cross-react with human tissue. Monoclonal antibodies derived from peripheral blood of patients showed cross-reactivity with myosin. Additionally, monoclonal antibodies generated against myosin and N-acetyl-beta-D-glucosamine isolates cross-react with tissue in the human heart valve of patients with rheumatic fever (Gandhi, Krishnamoorthy, Motal & Yacoub, 2017).
Patient’s autoreactive T cells work against cardiac tissues, including myosin and valve-derived proteins causing granulomatous inflammation in cardiac valves. The adherence of CD4+ T cells to the endothelium leads to subsequent infiltration of antibodies into the valve releasing γ -IFN. As informed by He et al. (2016), inflammation occurs followed by neovascularization further allowing infiltration of T-cells. T-cells respond against other cardiac proteins such as vimentin and tropomyosin, directs the formation of granulomatous lesions underneath the endocardium. As ARF is polygenic several immune coding genes are in association with ARF susceptibility.
Figure 2: Mechanism
(Source: He et al., 2016, 115)
Evaluating the role of the nurse in delivering suitable developmental nursing care for Sue
1. Developmental and Growth Theories
Growth is the physical change that happens with aspect ratio of height and weight, together with physical, hormonal, behavioural as well as mental changes, the development is said to be complete (Gewitz et al., 2015). In this case, Sue is mostly ignorant about her bodily changes and health. As explained by Havighurst’s Developmental Stage and Tasks, in middle childhood an individual tries to build health consciousness. However, in the present case study the Sue is not health conscious proved by the repeated incidence of bacterial infection. According to Havighurst’s bio-psychosocial model of development, as stated by Cardozo, Gonzalez, Feitosa, Pessoa and Rivera (2017), a person’s individual biology is influenced by...