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Pathophysiology-Respiratory Alterations
The pathophysiology of Mrs. Teel’s 7-month-old infant’s alteration is a persistent, lingering cough that has lasted for several months. The infant coughs mostly at nights and has had an allergic reaction to amoxicillin in the past. Aside from this, the infant appears healthy, the child’s breathing is clear to auscultation. The cough worsens when the baby cries but other than that the cough does not seem particularly bad. The mother is worried that it may be respiratory syncytial virus (RSV) but the pathophysiology of the infant’s symptoms does not align with RSV as the child demonstrates no lethargy or signs of fever. The most likely cause of the cough is an allergen and the child is simply having an allergic reaction, just as the infant had to amoxicillin. In the nighttime, the air cools off and pollen that is in the air settle back down to the ground where it is breathed in and can cause a cough in a child with allergies. The allergy could very well also be a food allergy that has gone unnoticed. In any event, there are no signs of infection or of RSV and this may easily be ruled out as the problem.
The factors of genetics and behavior may be impacting the child’s cough. Since the child has already demonstrated an allergy to amoxicillin, it is evident that the child does have allergies that need to be noted. The family history of the child should be considered when...
If the mother, father, brothers, sisters, grandparents, and so on have any history of allergies that this should be made known to the physician as it will help to make a determination on the likelihood of genetics being a factor in the child’s symptoms.
However, as Campbell, Boyle, Thornton and Prescott (2015) show, “allergic disease can be viewed as an early manifestation of immune dysregulation. Environmental exposures including maternal inflammation, diet, nutrient balance, microbial colonization and toxin exposures can directly and indirectly influence immune programming in both pregnancy and the postnatal period” (p. 844). In other words, allergies may be determined by a number of different variables and while genetics can be one factor to help explain onset, it is by no means the only factor to be investigated—and that is why the behavior of the infant is also important to discuss. Things to know include: what is the infant eating (what foods are part of his daily diet), is the children getting all of his essential nutrients, what is the child’s environment like—is the child in an environment with a high pollen count, etc. These types of questions can help to answer many questions about why the child is developing a cough that is persistent but that is not severe enough to be considered worrisome or that indicates a need for hospitalization. The child’s…
References
Campbell, D. E., Boyle, R. J., Thornton, C. A., & Prescott, S. L. (2015). Mechanisms of allergic disease–environmental and genetic determinants for the development of allergy. Clinical & Experimental Allergy, 45(5), 844-858.
McCance, K. L., & Huether, S. E. (2015). Pathophysiology-E-Book: The Biologic Basis for Disease in Adults and Children. Elsevier Health Sciences.
Subbarao, P., Anand, S. S., Becker, A. B., Befus, A. D., Brauer, M., Brook, J. R., ... &
Kozyrskyj, A. L. (2015). The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining developmental origins of allergy and asthma. Thorax, 70(10), 998-1000.
It has also been suggested that low-level viral replication associated with RSV may be a driver in chronic inflammation in some sufferers of chronic lung disease, although this is so far uncertain (Openshaw, 2005). It is estimated that infants who develop a wheeze as a result of RSV contraction develop a recurring wheeze in around two thirds of all cases. It is also estimated that around half of these children
, 2010). Regardless of the cause, infant RSV is linked to "significantly more symptoms of wheezing disorder and clinical allergy than controls and were more likely to be sensitized to common inhaled allergens" (Todd et al., 2010). The number of studies and the number of subjects is still small, but the correlations have been consistently large enough to suggest that a serious bout of RSV-bronchiolitis in infancy is linked to
R.'s secretions, administration of I.V. fluids to keep B.R. hydrated, and, prior to hospitalization, the administration of albuterol. B.R.'s breathing was labored and was not significantly improved by the interventions, although suctioning to clear the airways and the introduction of oxygen ensured adequate oxygen intake. Postiaux et al. found that the addition of prolonged slow expirations and provoked coughs could contribute "actively to a direct and immediate drainage of secretions" (2011).
Subtype a is the one that predominates in many of the outbreaks that are seen and presents much more severe clinical illness. It affects both the lower and the upper respiratory tract but is most prevalent in illnesses of the lower respiratory tract such as bronchiolitis and pneumonia. The obstruction of the airway in RSV can be very dangerous, and this is especially true of infants because their peripheral