NR 507 Week 7 – Disease Process Presentation – PART 3 Identify at least three subjective findings from the case:

NR 507 Week 7 – Disease Process Presentation – PART 3

Identify at least three subjective findings from the case:

In the case study presented, the patient stated that she was experiencing the following symptoms: sneezing, recurrent sinus infections, and nasal stuffiness that “seems to never go away.”

Identify at least three objective findings from the case:

If the patient were to visit the primary care office for an examination, objective findings for the patient who is experiencing allergic rhinitis present with rhinorrhea, bluish or pale swelling of the nasal mucosa, ocular issues like swollen conjunctivae and watery discharge (American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2015).

Management of the Disease

Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each:

The first strongly recommended medication class for the treatment of allergic rhinitis is intranasal steroids (INS) for those diagnosed with AR corticosteroids. Examples of intranasal steroids include Fluticasone propionate (Flonase) and Budesonide (Rhinocort propellant AQ). The second strongly recommended medication class for the treatment of AR would be second-generation H1-receptor antagonists, which are oral antihistamines. Examples of H1-receptor antagonists include Cetirizine (Zyrtec) and Fexofenadine (Allegra) (Seidman et al.2015).

Describe the mechanism of action for each of the medication classes identified above:

The mechanism of action for intranasal steroids was discovered through nasal allergen challenge models, which determined the significance of the reduction in a mediator and cytokine release with a decrease in nasal secretions through fewer basophils, eosinophils, neutrophils, and mononuclear cells. Overall, the reduction of the presence of these cells leads to a decrease in inflammatory cells and cytokines in the nasal mucosa. Intranasal steroids also inhibit the antigen-induced hyperresponsiveness of the nasal mucosa from reacting to the allergen. The onset of action for INS begins 3-5 hours to 36 hours after the first dose (Seidman et al.2015).

The mechanism of action for oral antihistamines includes a rapid onset of action causing the block of histamine toward the H1-receptor. Histamine lowers a high level of vascular permeability, which can lead to fluid traveling to areas of the body in surrounding tissues, which ultimately leads to swelling and the dilation of vessels. Antihistamines prevent this from occurring by becoming antagonists against the H1 receptors. There are first- or second-generation agents. The first-generation are lipophilic and can cross the blood-brain barrier. However, the second generation has limits to entering the central nervous system. The first-generation agents bind to the central and peripheral histamine-1 receptors, and the second-generation agents bind to peripheral H-1 receptors, which leads to differences in therapeutic actions and side effects. The duration of second-generation antihistamines works for 12-24 hours (Farzam, K., Sabir, S., & O’Rourke, M., 2020).