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Human Papilloma Virus Vaccine

Human Papilloma Virus Vaccine: Portfolio Case Studies- Nursing Case Study Assignment

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1. Case Study on Human Papilloma Virus vaccine
Sarah, aged 15 years, has received a full course (three vaccinations) of Gardasil, the human papilloma virus (HPV) vaccine, in the school-based immunisation programme to reduce her lifetime risk of cervical cancer. 1 (Reading “Defence 2” will help you answer the following questions).

1. Describe the primary immune response following vaccination.
2. Sarah may be exposed to one of the HPV viruses (targeted in the vaccine) when she is older.If this was to occur:
a. Describe the expected immune response.
b. Explain the effects on her cervical tissue/s.

2. Case Study on Hepatitis A virus
Charlie is 23 years old and recently returned home after travelling around South America. He visited his general practitioner after feeling unwell and noticing a discolouration of his skin. After appropriate blood tests and examination, he has been diagnosed with Hepatitis A virus.
1. Discuss the most likely ways in which Charlie was exposed to Hepatitis A virus.

2. Describe the activation of, and the role, of the T killer cells (CD8), in clearing this virus.

3. Recently a small number of children in New Zealand have been infected with Hepatitis A from eating frozen berries imported from South America. If Charlie was to eat Hepatitis A contaminated berries in the future, is he likely to become infected with Hepatitis A? Explain your rationale.

3. Case Study on Meningitis
After you have completed all the readings, activities and watched the video on meningitis, work through the following case study and answer the questions below for your portfolio.

Sam, who is six years old, was brought into his local Accident and Medical Clinical by his parents with his 4-week old sister called Emma. The attending nurse and physician suspected Sam might have meningitis caused by the bacterium “Neisseria Meningitidis”. He was immediately given intramuscular benzyl penicillin (penicillin G) and transferred by ambulance to hospital, where he later tested positive for the meningococcal sero group B.
1. Describe the primary immune response and how it attempts to destroy Neisseria Meningitidis.

2. Sam’s parents are particularly upset about the diagnosis as Sam had received the full course of the MeNZBTM vaccine (that included the meningococcal sero group B) from the practice nurse at their general practice. They would like to know why he now has meningitis. Discuss the most likely reason Sam has contracted meningitis.

3. Understandably, Sam’s parents are particularly concerned that Emma may also get meningitis because she has not yet been immunised. Explain why Emma is most unlikely to contract meningitis.

4a. Cardiovascular Disease – Adult Case Study (Complete 4a OR 4b) Mr Scott, is 79 years old and is attending a follow-up appointment at the cardiology outpatient clinic. He has a history of cardiovascular disease (CVD), angina, atrial fibrillation, hypertension and elevated low-density lipoprotein cholesterol. Over the past six years he has had two myocardial infarctions (MI) and a minor stroke. Currently, Mr Scott finds it difficult to breathe lying down and fatigues easily when walking. Further assessments reveal the following clinical signs and symptoms:
1. Blood pressure 150/90 mmHg
2. Heart rate 100 beats / minute
3. Respiratory rate 18 / minute
4. Total cholesterol 5.2 mmol/L
5. Low Density Lipoprotein cholesterol (LDL-C) = 3.8mmol/L
6. High Density Lipoprotein cholesterol (HDL-C) = 0.7mmol/L
7. Dyspnea (shortness of breath)
8. Peripheral oedema
9. A cardiac echocardiogram showed enlarged ventricles with an ejection fraction of 45%. Based on Mr Scott’s presentation and test results he is diagnosed with heart failure. Clinical management is aimed at reducing his risk of further major cardiovascular events. Mr Scott is currently prescribed cilazapril, diltiazem (cardizem), aspirin, atorvastatin and furosemide

Case Study Questions
1. Based on Mr Scott’s profile describe the typical progression from atherosclerosis through to heart failure. The review by Kemp and Conte 2 may help you answer this question.
2. In relation to calcium channel blockers (i.e. diltiazem):
i) Outline their biological or mechanism of action and their main effect on the cardiac function.
ii) State the number needed-to- treat (NNT) for people prescribed a calcium channel blocker, who are at increased risk of having a major cardiovascular event. Refer to a published report, or calculate an NNT and include the number of years that people need to-be- treated to prevent one adverse outcome. The database Dynamed or the review by Bui 3 and the on-line tutorial on NNT will assist you in understanding and answering this question. Remember to reference the report you refer to, or study you have used, for calculating NNT.

4b. CV Paediatric Case Study
Aroha, twelve years old, has been admitted to the paediatric cardiology ward with suspected mitral valve dysfunction following a history of Rheumatic Fever. After a full investigation, she is formally diagnosed with mitral valve stenosis.
1. The incidence of Rheumatic Fever is higher among Maori and Pacific children compared to European children in New Zealand. 4 Discuss reasons for this ethnic disparity.
2. Discuss the effect of mitral valve stenosis on tissue perfusion and reduced ability to exercise.
3. Pulmonary oedema may result from mitral valve stenosis. Explain the relationship between mitral valve stenosis and pulmonary oedema.

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