Advanced Patho-NURS 6501-Wk10 Assgn PDF

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Nurs 6501 Advanced Pathophysiology week 10 assignment- high score...

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Module 7 Assignment: Case Study Walden University NURS 6501N: Advanced Pathophysiology

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Module Assignment: Case Study Introduction Based on the presenting symptoms and test results described in the case study, the 32year-old female developed gonorrhea infection, which is a typical type of sexually transmitted disease that can be local or systemic (McCance & Huether, 2019). Gonorrhea is caused by gonococci microorganisms of the species Neisseria gonorrhoeae. Common complications of gonorrhea include pelvic inflammatory disease (PID), disseminated infection, and sterility (McCance & Huether, 2019). The Factors that Affect Fertility Infection agents such as bacteria, viruses, and fungi can greatly impact reproduction and pregnancy in humans (Smolarczyk et al., 2021). According to Len and Dillard (2018), Neisseria gonorrhoeae is an obligate human pathogen that causes mucosal surface infections of female and male reproductive tracts, rectum, pharynx, and conjunctiva. Infections in the lower reproductive tract of women can lead to long-term consequences if it ascends into the fallopian tube. The damage caused by gonococcal infection and the subsequent inflammatory response produces the condition known as pelvic inflammatory disease (PID). During the infection, the ciliated epithelium of the uterine tubes is permanently damaged the fertilized ova (Burnham et al., 2015). Furthermore, the infection can also lead to tubal scarring, occlusion of the oviduct, and loss of critical ciliated cells. Consequences of the damage sustained on the fallopian tube epithelium include increased risk of ectopic pregnancy and tubal factor infertility (Len & Dillard, 2018). Impaired fertility is a major concern in women with a history of PID. Of women with tubal factor infertility, 50% have no history of PID but have scarring of the fallopian tubes.

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Scarring and adhesions of the tubes further impair fertility (McCance & Huether, 2019). The rate of infertility increases with the number of episodes of infection. The risk of ectopic pregnancy is increased 15-50% in women with a history of PID (McCance & Huether, 2019). Infectioninduced selective loss of ciliated epithelial cells along the fallopian tube epithelium can cause impaired ovum transport, resulting in tubal-factor infertility or ectopic pregnancy (Burnham et al., 2015). Genetically mediated variation in immune response plays an important role in susceptibility to PID. Studies have found that variants in the genes that regulate toll-like receptors (TLRs), a component in the innate immune system, have been associated with an increased progression of N. gonorrhoeae infection to PID (DeSapri & Christmas, 2019). Economic status is an important factor in developing infection-induced infertility globally. Low-income populations normally lack health insurance coverage and will not seek for medical help unless the symptoms of STD or PID get severely progressed, which already infected the reproductive system. Most low-income clinical settings rely on syndromic management without diagnostic tests and most N. gonorrhoeae infections in women are asymptomatic and missed the diagnosis (Burnham et al., 2015). The World Health Organization stated that vaccines and other strategies to prevent PID lie at the heart of efforts to improve women’s reproductive health (Burnham et al., 2015). Educational programs to reinforce safe sex can also lower the risk of sexually transmitted disease thus reducing infection-induced infertility. Why Inflammatory Markers Rise in STD/PID There are few inflammatory markers elevated in this case. Firstly, the patient’s WBC count is 18 (normal range is 4.5 to 11x109/L). Secondarily, the C reactive protein (CRP) level is 67 mg/L, which is elevated. Levels between 10 mg/L and 100 mg/L are usually due to more

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significant inflammation from an infectious cause. CRP is a substance that the liver makes in response to inflammation, and it measures the amount of this protein in the blood. This test helps to diagnose acute and chronic conditions that cause inflammation. Thirdly, erythrocyte sedimentation rate (ESR), the normal range of ESR is from 0 to 29 mm/hr for women and this patient’s ESR rate is 46mm/hr, which indicated inflammation. To support the diagnose of PID, the ESR, the CRP level, and gonococcal DNA probes and cultures, endometrial biopsy, imaging studies (eg, ultrasonography, computed tomography [CT], and magnetic resonance imaging [MRI] may be helpful (DeSapri & Christmas, 2019). The rise of the above inflammatory markers is a part of the body’s immune response to gonococcal infection. Lenz and Dillard (2018) pointed out that the infection is capable of inducing transcription of numerous cytokines and chemokines in epithelial cell lines. In the fallopian tubes, the innate T-cells, granulocytes, and dendric cells are abundantly present. Cervical infection with N. gonorrhoeae ascends to the fallopian tube, then leads to salpingitis and pelvic inflammatory disease (Lenz & Dillard, 2018). The adaptive immune response plays a role in the pathogenesis of PID because reinfection substantially increases the risk of tubal-factor infertility (Brunham et al., 2015). Explain the Patho that Produces the Case Study Patients Symptoms Transmission of gonococcal infection starts with the contact of epithelial (mucosal) surfaces, and it occurs during vaginal, oral, or anal intercourses (McCance & Huether, 2019). Commonly, infections with N. gonorrhoeae begin at the endocervical canal (inner portion of the cervix) in females, which divides the lower reproductive tract and the upper reproductive tract (Lenz & Dillard, 2018). Cervical infections can be symptomatic or asymptomatic, and untreated

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cervical infections ascend to causes infections of the upper female reproductive tract, including the fallopian tubes and endometrium. During intercourse, bacteria adhere to sperms or body secretions and be transported to the fallopian and uterine tubes. Once gonococci are in the fallopian tubes, progressive mucosal and submucosal invasion of the tissues can cause sloughing of ciliated tubal epithelium and a marked inflammatory response, causing the tubes filled up with exudates (McCance & Huether, 2019). In this case, the gram-negative diplococci are present at the wet prep test. Gram stain microscopy is an effective tool to identify suspicious bacteria (Rashbrook et al., 2017). Foulsmelling discharge from vaginal plus the red cervix further confirmed the source of infection. Additionally, the patient developed PID and clinical manifestations include chills, fever, nausea, vomiting, lower abdominal, and pelvic pain. Abdominal palpation often discloses bilateral lower quadrant tenderness and positive chandelier signs (McCance & Huether, 2019, p.2775). A pregnant woman can transmit gonorrhea to her fetus through infected cervical and vaginal secretions contacting the baby’s mucosal surfaces during birth. If untreated, a newborn’s gonococcal eye infection and blindness can occur (McCance & Huether, 2019). Concurrent or isolated oropharyngeal and anorectal infections can also be found in affected women and men. A rare systemic complication caused by the spread of N. gonorrhoeae in the bloodstream is called disseminated gonococcal infection [DGI] (McCance & Huether, 2019). Symptoms include severe joint pain, meningitis, and endocarditis (Workowski & Bolan, 2015).

Conclusion

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Gonorrhea is a common sexually transmitted disease caused by N. gonorrhoeae. Common complications include pelvic inflammatory disease (PID) and infection leads to a higher risk of developing infertility. Loss of the ability of ciliated cells to participate in transporting the fertilized ovum to the uterus is considered a major predisposing factor for tubal factor infertility and ectopic pregnancy. Peritoneal adhesions along the fallopian tubes may prevent pregnancy. Apart from unsafe sexual behaviors, social economics plays a role in developing infection-induced infertility. Vaccines and other strategies to prevent PID lie at the heart of efforts to improve women’s reproductive health. Addressing the economic, social, cultural, and behavioral determinants of STD are the keys to prevent the infection.

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References Balla, F., Ismaili, B., Demaiaj, E., & ELMASLLARI, A. (2020). The incidence and prevalence of pelvic inflammatory disease and its impact in infertility, pelvialgy and surgical interventions. Romanian Journal of Medical Practice, 15(3), 307–312. https://doiorg.ezp.waldenulibrary.org/10.37897/RJMP.2020.3.9 Brunham, R. C., Gottlieb, S. L., & Jorma, P. (2015). Pelvic inflammatory disease. The New England Journal of Medicine, 372(21), 2039-2048. https://dx.doi.org.ezp. waldenulibrary.org/10.1056/NEJMra1411426 DeSapri, T. K. & Christmas, M. M. (2019). Pelvic inflammatory Disease. https://emedicine.medscape.com/article/256448-overview#showall Lenz, J. D., & Dillard, J. P. (2018). Pathogenesis of Neisseria gonorrhoeae and the host defense in ascending infections of human fallopian tube. Frontiers in Immunology, 9, 2710. https://doi-org.ezp.waldenulibrary.org/10.3389/fimmu.2018.02710 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier. Rashbrook, S., Bittencourt-Vargas, I., & Grundy-Bowers, M. (2017). Evaluating the effectiveness of gram stain microscopy in identifying gram negative intracellular diplococci suggestive of Gonorrhoea Neisseria. SEXUALLY TRANSMITTED

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INFECTIONS, 93, A68. https://doi-org.ezp.waldenulibrary.org/10.1136/sextrans-2017053232.199. Smolarczyk, K., Mlynarczyk-Bonikowska, B., Rudnicka, E., Szukiewicz, D., Meczekalski, B., Smolarczyk, R. & Pieta, W. (2021). The impact of selected bacterial sexually transmitted diseases on pregnancy and female fertility. International Journal of Molecular Sciences, 22(2170), 2170. https://doi-org.ezp.waldenulibrary.org/10.3390/ijms22042170. Workowski, K. A. & Bolan, G. A. (2015). [Centers for Disease Control and Prevention]. Sexually Transmitted diseases treatment guidelines. MMWR Recomm Rep,64 (RR-03):1-137....