Alterations in Immunity

Donna, a twenty-one-year-old nursing student, comes to her nurse practitioner in December with a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every spring and fall.

Physical Examination

Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal

Skin: Flaking erythematous rash on the flexor surfaces of both arms

Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage

Lungs: Clear to auscultation and percussion

Answer the questions about Donna and her condition and provide a pathophysiological response in the body. Examine and describe the pathophysiology associated with the possible disease.

• What is the possible disease process according to the client’s history?
• What assessment questions would be useful to ask about her medical and family history?
• What evidence presented in the case study suggest  that Donna does not have an acute severe infection?
• If Donna has allergic rhinitis, what type of hypersensitivity reaction is involved?