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Understanding Signs, Symptoms, and Pathophysiology

  • 11 Pages
  • Published On: 28-11-2023
Introduction

The knowledge of signs and symptoms of health issues or diseases is important as they help in initial diagnosis of the disease and determine the diagnostic test to be performed to confirm the health issue. The pathophysiology of disease explains the changes in the internal functions of the body that lead to the rise of the disease. Thus, the signs and symptoms along with pathophysiology of few diseases are to be discussed.

Section 1

Asthma is a respiratory disorder in which the individuals express signs and symptoms of shortness of breath, wheezing sound during exhaling, chest tightness, trouble sleeping due to breathlessness and extensive coughing and others (James and Lyttle, 2016). The pathophysiology of Asthma includes complex steps initiating from airway inflammation to intermittent obstruction of airflow and bronchial hyperresponsiveness (King et al., 2018). In asthma, the airway inflammation occurs due to interplay between leucocytes and respiratory epithelium as a result of allergic reactions. Moreover, the environmental, as well as inflammatory stimuli, induces stimulation of mediators from the epithelium in the airway that recruits and activates the inflammatory cells in the inner lining of the airways leading to airway inflammation (Muc et al., 2016). The inflammation of the airways causes narrowing of the trachea that limits or restricts the flow of air to and from the lungs. Further, the production of increased mucus results to cause resistance in the airflow leading to cause shortness of breath (Foong et al., 2016). The bronchial hyperresponsiveness is the phase in which the bronchioles or small airways in the lungs gets constricted which is usually caused by the release of mediators such as histamine, leukotrienes and others from the inflammatory cell. It leads to cause hindrance in the entry and exist of air from the lungs making the individual show symptoms of asthma (Gao et al., 2020).

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The clinical assessment of asthma includes initially physical examination to determine the presence of the disease by the nature of the signs and symptoms. The diagnostic test for clinical assessment of asthma includes spirometry test and bronchodilator challenging test. In spirometry test, the FEV1 value below 70% is considered that the patient is suffering from breathing problem which may be asthma (Heffler et al., 2018). In bronchodilator challenging test, the patient is provided methacholine and asked to perform actions that trigger asthma. After the action, the spirometry test is again performed and of the test values are not normal it indicates that the person is suffering from asthma (Bins et al., 2020).

The signs and symptoms of epilepsy/seizure are staring spell, temporary confusion, uncontrolled jerking movement in the legs and arms, unconscious feeling and psychic symptoms like anxiety, fear and others (Elger and Hoppe, 2018). The pathophysiology of epilepsy involves shifting in the balance between the excitatory neurotransmitter which is glutamate and inhibitory neurotransmitter which is γ-aminobutyric acid (GABA). The occurrence of the shifting is because of selective reduction of the inhibitory GABA-ergic neurons after precipitation of the epileptogenic insults such as traumatic brain injury, stroke, etc and reorganisation of the circuits of neurons which favours hypersynchronisation of the neuronal population. This shifting cause abnormality in the brain electrical properties leading the individual to develop seizures (Mattison et al., 2018).

The clinical assessment of epilepsy/ seizure is executed by using electroencephalogram (EEG). In this assessment, the electrodes are attached on the scalp with a cap or paste-like substance to record electrical activity in the brain. In epileptic patients, the brain wave express change from the normal pattern seen in individual leading toward detection of the disease (Elger and Hoppe, 2018). The EEG report also helps to provide information to the physicians to detect the nature of seizure faced by the patient by analysing the pattern of brain electrical activity (Elger and Hoppe, 2018). The CT scan is also performed for clinical assessment of epilepsy/ seizure. In this test, the X-ray are used to develop images of the brain to determine if there are abnormalities such as cysts, tumour or others in the brain that is causing the seizure (Elger and Hoppe, 2018).

Anaphylaxis is a rare yet severe allergic reaction which express symptoms of changes in skin such as hives or itching or pale skin, low blood pressure, narrowing of the airways followed by swollen tough or throat, weak and rapid pulse, dizziness, vomiting and nausea (Turner et al., 2017). The pathophysiology of anaphylactic shock involves two mechanisms which are immunologic and non-immunologic. In immunologic mechanism, the immunoglobulin E (IgE) develop binding with the foreign material responsible for stimulating the allergic reaction known as antigen. The IgE bound to the antigen activates the high-affinity IgE receptor present on basophils and mast cells which causes release of inflammatory mediators like histamines and others. The mediators subsequently lead to increase the contraction and narrowing of the bronchial smooth muscles along with triggers vasodilation which lower blood pressure and increase fluid leak from the blood vessels contributing to skin reaction and muscle depression (Yanagida et al., 2018).

The non-immunogenic mechanism in anaphylaxis involves substances which causes direct degranulation of the basophils and the mast cells leading to cause the expression of mediators as seen in immunogenic mechanism (Okamoto et al., 2019). The clinical assessment of anaphylactic shock initially includes the physician making physical assessment and examination of the allergic reaction history in the patient. The physician to confirm the diagnosis of anaphylactic shock is going to use blood test to measure the presence of level of tryptase enzyme in the body. This is because the specific enzyme is seen to remain elevated than the normal level till three hours after the shock (Bouzillé et al., 2018). Further, allergic and kin tests are to be performed to determine the trigger or allergen responsible for causing the shock to avoid future relapse of the health issue (Bouzillé et al., 2018).

The pneumonia is the disease in which infection occurs in the lungs due to fungi, virus or bacteria. The sign and symptoms of pneumonia include coughing, fever, sweating, shortness of breath, shallow breathing, stabbing feeling in the chest, low energy and others (Marchello et al., 2019). In bacterial pneumonia, the bacteria are considered to enter through the small aspiration and get deposited in the nose and throat. The bacteria such as Legionella penumophila and Myobacterium tuberculosis enter the lungs through the contaminated air droplets. The bacteria on entering the lungs invade the spaces present between the alveoli and cells where they are attempted to be inactivated by macrophages and neutrophils which causes the feeling of fever, chills and fatigue in bacteria pneumonia as an effect on the immune system (Bhuiyan et al., 2019).

In viral pneumonia, the viruses reach the lungs through different routes such as respiration, blood and others. The virus on reaching the upper airway invades the inner lining of the airways which leads them to cause certain degree of cell death in the areas. The reaction of the immune system to the virus causes increased damage to the inner lining of lung consisted of alveoli. The increased damage in the lungs and alveoli causes disruption of the absorption of adequate amount of oxygen in the blood and hindered proper breathing leading to shortness of breath and others (Ishiguro et al., 2019). The Chest X-ray is used for clinical assessment of pneumonia where the image is determined to identify the extent of spread of the condition. This is because in pneumonia the bacteria invade the space between the alveoli and cells along with neutrophils and fluid from nearby blood vessels are seen to fill the alveoli causing the consolidation seen in the X-ray report of pneumonia patients (Al-Baadani et al., 2019). The blood test is also performed for clinical examination of the pneumonia to determine the type of microorganism responsible in causing the disease (Al-Baadani et al., 2019).

Section 2

Pain referred as distressing sensation along with hindered emotional experience which is linked to potential tissue damage with the key purpose of notifying the defence system of the body to react toward a certain stimulus to avoid further damage to the tissues in the body (Peng et al., 2019). The four major types of pain are nociceptive pain that occurs due to tissue injury, inflammatory pain that occurs due to inappropriate response from the body's immune system, functional pain which occurs without obvious reason and neurotic pain that occurs due to nerve irritation (Peng et al., 2019).

The Socrates is a nature of pain assessment framework which is used in the emergency medical services by the physicians, nurses and other health professionals for evaluating the nature of pain being experienced by the patient. The Socrates is mainly a mnemonic acronym in which S indicates site that is asking the patient in which site of the body they are experiencing maximum pain. The O indicates onset which is identifying when the pain initiated and whether it is sudden or gradual and regressive or progressive. The C indicates character which is determining the likeness of pain (ache or stabbing) and R indicates radiation that is identifying if the pain is spreading to additional areas. The A stands for association that is whether it is related with other pain, T stands for time course that is identifying any change in pattern of pain over time, E stands for exacerbating that is identifying if there are any change in the pain and S stands for severity that is how bad is the current pain perceived by the individual (Caraceni and Shkodra, 2019). Thus, the framework is effective in detecting and monitoring the pain perceived by patients under emergency condition without waste of time.

The sepsis is a serious infection which cause the immune system to attack healthy cells of the body and destroy them. The pathophysiology of sepsis mainly includes the effect of immune system in spreading the disease in the body. Sepsis does not develop in the body from it own but requires another medical condition like infection in the lungs, skin, abdomen and others in the body. The invasive medical procedure such as catheter insertion also leads to transmission of bacteria in the body which acts as the key causative agent in sepsis. In innate immunity, the blood vessels widen in the infected tissue for increasing blood circulation in the part so that white blood cells (WBCs) arrive in the affected area and attack the infection causing agents such as bacteria (Lv and Wang, 2016).

The activation of the first line of cellular defence action leads to excessive release of cytokinesis and other inflammatory regulators that are responsible for causing hypotension and vasodilation (Lv and Wang, 2016). The increased permeability of the tissue leads to allow immune cells and WBCs in entering the affect area and invade the pathogens. Sepsis is seen to occur when this responses in the innate immunity against a certain foreign agent gets amplified and dysfunctional. This is because it leads to create imbalance in the anti-inflammatory and pro-inflammatory response (Lv and Wang, 2016). The cytokines are responsible in managing wide range of inflammatory responses. However, the uncontrolled release of cytokines causes vasodilation along with increased permeability of capillaries and destruction of normal epithelial cells which usually act as protective barrier in avoiding damage to the organ. This is evident as epithelium protects the entry of the pathogens inside the organs to avoid its dysfunction. The resulting leakage caused by destroyed epithelial cells leads to hypotension along with macromolecular extraversion, edema and other that are frequently seen in sepsis patients (Lv and Wang, 2016).

In the adult nursing field, from the pathophysiological perspective it is determined that obesity impact the body to become blunt in responding to use fats taken in the body. This lead to raise the LDL cholesterol in the blood as the LDL cholesterol clearance from the blood is reduced (Fan et al., 2019). The presence of high cholesterol leads the body to be at risk of cardiovascular disease. Moreover, the presence of obesity impacts the body to develop type-2 diabetes. This is because fat deposition in the body leads to create barrier for the body cells to absorb extra glucose from the blood to be used for functional purpose. It causes to raise the blood sugar and make the individuals experience hyperglycaemia (Kindler et al., 2020). The presence of obesity impacts the body to develop high blood pressure that eventually leads the individual to be at increased risk of cardiovascular disease. This is because in obesity high amount of fat is seen to get deposited in the body and some of fats also initiate to get deposited on the inner lining of the arteries which causes them to be constricted. The narrowed blood vessels cause to create increased pressure for flow of blood in the body leading towards high blood pressure. In addition, increased body weight due to obesity leads the heart in the body to pump harder in meeting the requirement of blood that put strains on the artery and cause development of high blood pressure (Köchli et al., 2018).

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Conclusion

The above discussion informs that pathophysiology of disease include inflammation in the lungs, hindered brain reflexes and others. The use of effective clinical assessment is required in each disease which are mostly specific to the diseases in enhanced diagnosis of the health problem.

References

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Bhuiyan, M.U., Snelling, T.L., West, R., Lang, J., Rahman, T., Granland, C., De Gier, C., Borland, M.L., Thornton, R.B., Kirkham, L.A.S. and Sikazwe, C., 2019. The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case–control study. Thorax, 74(3), pp.261-269.

Bins, J.E., Metting, E.I., Muilwijk-Kroes, J.B. and Kocks, J.W.H., 2020. The use of a direct bronchial challenge test in primary care to diagnose asthma. NPJ primary care respiratory medicine, 30(1), pp.1-8.

Bouzillé, G., Osmont, M.N., Triquet, L., Grabar, N., Rochefort‐Morel, C., Chazard, E., Polard, E. and Cuggia, M., 2018. Drug safety and big clinical data: Detection of drug‐induced anaphylactic shock events. Journal of evaluation in clinical practice, 24(3), pp.536-544.

Caraceni, A. and Shkodra, M., 2019. Cancer pain assessment and classification. Cancers, 11(4), p.510.

Elger, C.E. and Hoppe, C., 2018. Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection. The Lancet Neurology, 17(3), pp.279-288.

Elger, C.E. and Hoppe, C., 2018. Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection. The Lancet Neurology, 17(3), pp.279-288.

Fan, J., Liu, Y., Yin, S., Chen, N., Bai, X., Ke, Q., Shen, J. and Xia, M., 2019. Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation. Nutrition & metabolism, 16(1), p.7.

Foong, R.E., Bosco, A., Troy, N.M., Gorman, S., Hart, P.H., Kicic, A. and Zosky, G.R., 2016. Identification of genes differentially regulated by vitamin D deficiency that alter lung pathophysiology and inflammation in allergic airways disease. American Journal of Physiology-Lung Cellular and Molecular Physiology, 311(3), pp.L653-L663.

Gao, J., Wu, H.G. and Wu, F., 2020. Small Airways Dysfunction and Bronchial Hyper-Responsiveness in Cough Variant Asthma. International Journal of General Medicine, 13, p.1427.

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Ishiguro, T., Kobayashi, Y., Uozumi, R., Takata, N., Takaku, Y., Kagiyama, N., Kanauchi, T., Shimizu, Y. and Takayanagi, N., 2019. Viral pneumonia requiring differentiation from acute and progressive diffuse interstitial lung diseases. Internal Medicine, 58(24), pp.3509-3519.

James, D.R. and Lyttle, M.D., 2016. British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014. Archives of Disease in Childhood-Education and Practice, 101(6), pp.319-322.

Kindler, J.M., Kelly, A., Khoury, P.R., Katz, L.E.L., Urbina, E.M. and Zemel, B.S., 2020. Bone Mass and Density in Youth With Type 2 Diabetes, Obesity, and Healthy Weight. Diabetes Care, 43(10), pp.2544-2552.

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Marchello, C.S., Ebell, M.H., Dale, A.P., Harvill, E.T., Shen, Y. and Whalen, C.C., 2019. Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: a systematic review and meta-analysis. The Journal of the American Board of Family Medicine, 32(2), pp.234-247.

Mattison, K.A., Butler, K.M., Inglis, G.A.S., Dayan, O., Boussidan, H., Bhambhani, V., Philbrook, B., da Silva, C., Alexander, J.J., Kanner, B.I. and Escayg, A., 2018. SLC 6A1 variants identified in epilepsy patients reduce γ‐aminobutyric acid transport. Epilepsia, 59(9), pp.e135-e141.

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Okamoto, K., Kagami, M., Kawai, M., Mori, Y., Yamawaki, K., Nakajima, Y., Kondo, Y. and Tsuge, I., 2019. Anaphylaxis to xylitol diagnosed by skin prick test and basophil activation test. Allergology International, 68(1), pp.130-131.

Peng, W., Huang, X., Liu, Y. and Cui, F., 2019. Predictability modulates the anticipation and perception of pain in both self and others. Social Cognitive and Affective Neuroscience, 14(7), pp.747-757.

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Yanagida, N., Sato, S., Takahashi, K., Nagakura, K.I., Asaumi, T., Ogura, K. and Ebisawa, M., 2018. Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge. Pediatric Allergy and Immunology, 29(4), pp.417-424.


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