Case Studies Tasks

In: Nursing

Case Studies Tasks: Susan and Joe had a wonderful little boy named Daniel, but he had…

Case Studies Tasks:

Susan and Joe had a wonderful little boy named Daniel, but he had been having an awful lot of bacterial infections and he was barely a year old. It seemed that the antibiotics cleared up one bacterial respiratory infection only to have another follow shortly. The scary thing was that Daniel had just fought off a case of pneumonia caused by Pneumocystis carnii, a fungal infection that was usually found in people with HIV. Waiting for the test results of an HIV test for their little boy was one of the worst experiences ever. Thank goodness it came back negative. However, it seemed that their troubles were just beginning. After this last lung infection, the fungal one, and a negative HIV test, their doctor had ordered a number of other blood tests, including a genetic test that Susan didn’t fully understand. Apparently the doctor was worried about Daniel’s immune system functions. Susan had also met with a genetic counselor who collected a family history of any immune disorders. The details were vague, but Susan’s mother, Helen, knew that one of her three brothers had died young from an unexplained lung infection. Unfortunately, Grandma Ruth had passed away a few years ago, leaving them with numerous unanswered questions. Susan and Joe had an appointment with their doctor that afternoon to go over the results. When they arrived Dr. Dresdner led them into an office where Ms. Henchey, the genetic counselor, waited. This can’t be good, thought Susan. The doctor began by explaining that they had analyzed Daniel’s blood and found that while he had normal levels of B cells and T cells, his antibody levels were anything but normal. The levels of IgG, IgA, and IgE were very low, almost undetectable, and Daniel had abnormally high levels of IgM and IgD. It appears that his immune system failed to undergo immunoglobulin isotype switching due to a CD40 ligand mutation in Daniel’s DNA.

1.Diagram an antibody response graph for a normal 1st and 2nd exposure with the antibodies correctly labeled for each exposure. Then diagram what Daniel’s graph would look like, based on his situation.

2.Diagram and/or explain why IgG is low and what CD40’s role is? Why is a mutation in that gene a problem? (There is no specific diagram I am looking for here, either diagram it or explain it, depending on which you prefer.)

Charlotte: A 60-year-old woman was fit and well until late in the summer she was out tending to her lovely tulip garden when she was stung on the back of her right hand by a pesky wasp. This was nothing new, unfortunately as she had been stung a couple times in the last two weeks. With in minutes after this sting Charlotte fell to the ground and looked as though she was becoming pale/grayish and was gasping for air. After five minutes it was getting worse, but likely a neighbor doctor rushed over and administered an epinephrine shot, which provided support until the ambulance could arrive.

1.Which antibodies and cells are involved in this allergic reaction and how does it lead to anaphylaxis?

2.Why didn’t this happen on the first stings? How does anaphylaxis impact the body and how did the epinephrine help?

Jessalyn: Jessalyn regularly goes in for blood transfusions. Jessalyn’s blood type is A-. Normally her blood transfusions go well and her nurse, Traci, does a great job of double checking the blood type she is receiving. This time Traci is out of town and she gets a nurse who was able to skate through school doing the bare minimum and doesn’t really care that much about his job. He doesn’t double check the blood type for her transfusion and . . . The blood type was incorrect.

1.Diagram and/or explain what happened.

2.Which blood types could Jessalyn receive, why?

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