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Running head: NRSG257NRSG257Name of the StudentName of the UniversityAuthor note
1NRSG257The paper deals with the discussion of case study of Sue. She is a 14-yar-old girl treatedfor streptococcal pharyngitis and impetigo over last two years. She was advised to takesecondary prophylaxis program to reduce risk for Acute Rheumatic Fever (ARF). As she is anindigenous girl residing in a remote area, she failed to attend the clinic and receive herantibiotics. After this, she presented with acute joint pain, sore throat with body temperature of38°C. Finally, she was diagnosed with ARF and need cardiology review and echocardiogram.Therefore, the following essay discusses the pathophysiology of her present condition and role ofnurse in the development of nursing care and in providing family centered care. Pathophysiology Streptococcal pharyngitis is the infection or irritation of tonsils or pharynx and of viralorigin. Streptococcus pyogenesis the significant bacterial agent that causes pharyngitis inchildren called GAS infection (Hoffman, 2014). Viruses or bacteria invade the pharyngealmucosa directly and causes a local inflammation. After invasion, they release extracellularproteases and toxins and caused by group A beta-hemolytic streptococcus(GAS). It is the mostcommon pharyngitis causes 15-20% of the infections (Fierro et al., 2014). It is contagious innature and spread through contact. In the given case study, Sue was treated for repeatedstreptococcal pharyngitis and impetigo episodes over the last two years. The virulent factor of GAS is M protein. The protein is located peripherally over the cellwall and causes invasive infection. Cells are exposed to the M protein that causes cross-reactionwith epitopes of laminin and cardiac myosin that contribute to impetigo and acute rheumaticdisease. Impetigo being the most common bacterial infection infects children on the superficiallayers of epidermis by Staphylococcus aureus or Streptococcus pyogenes. This secondary skin
2NRSG257infection infected Sue that caused impetigo or scarlet fever or school sores due to GAS infection(O'Meara et al., 2015). As she lives in a remote area, she failed to turn for the second prophylactic program toprevent ARF risk or Rheumatic Heart Disease (RHD). This aggravated to cause ARF in her thatrequired echocardiogram and cardiology review. RHD is a post infection systemic complicationcaused by S. Pyogenes, although exact pathophysiology is not known. It developed in Sue postpharyngitis where the organism is attached to the epithelium of upper respiratory tract andinitiates a cascade of enzymatic reactions that help them to invade and damage human cells andtissues (Lee et al., 2016). After the three to four days incubation period, the organism invadesand triggers acute inflammatory response causing acute joint pain, sore throat that migrated toknees and ankles with elevated body temperature. This shows that Streptococcus impetigo causespredisposition to ARF or RHD. This was witnessed in Sue where she reported sore throat, acutejoint pain radiating to ankles and knees indicating ARF. Evaluation of nursing role and care For the proper diagnosis and care for Sue, the nurse should be aware of the growth anddevelopment expected at her age. Sue is 14 year-old-girl and expected developmental milestonesat her age is formal operational stage as stated by Jean Piaget’s theory of adolescentdevelopment. At Sue’s age, they learn to think in an abstract manner in solving problems andthink symbolically about things that are not concrete according to them. At the age of 14 years,they are able to think in a complex manner and express their feelings in a better way by talking.They have a strong sense of right and wrong as compared to children and towards gaining
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