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Donna, a twenty-one-year-old nursing student, visits her nurse practitioner in December after complaining of itchy eyes and nasal congestion with watery nasal discharge for five weeks. She also has a â€tickling†cough, particularly at night, and has had episodes of repetitive sneezing. Every spring and fall, she suffers from â€colds.â€

Examination of the Physical

Afebrile; respiratory rate, pulse, and blood pressure are all normal.

Skin: An erythematous rash with flaking on the flexor surfaces of both arms.

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

Lungs: Exempt from auscultation and percussion.

Respond to the questions about Donna and her condition by describing a pathophysiological response in the body. Examine and describe the pathophysiology of the potential disease.

What is the most likely disease process based on the client’s history?
What assessment questions about her medical and family history would be useful to ask?
What evidence indicates that Donna does not have a severe acute infection?
What type of hypersensitivity reaction is involved in Donna’s allergic rhinitis?


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