NURS 6501 Discuss Alterations in Cellular Processes
NURS 6501 Discuss Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
To prepare:
- By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
Discussion: Alterations in Cellular Processes
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Main Discussion Post: Week One
In this week’s particular scenario, a 16-year-old boy with an unremarkable history and no allergies is diagnosed with streptococcal pharyngitis after a proper physical examination and a rapid strep test is performed. Due to the patient’s lack of allergies, he is given an amoxicillin 500 mg to take every 12 hours for 10 days. He takes his first dose upon arriving home and develops an immediate response of swelling to his tongue and lips and difficulty breathing. He receives emergency treatment for his reaction after 911 is notified. The purpose of this discussion is to explain the highlighted disease in this scenario.
The Role of Genetics in the Disease
It can be deduced from the scenario that the 16-year-old boy had an anaphylactic reaction to the oral amoxicillin, an aminopenicillin. Having been in use since the 1970s, they are recognized as the most common cause of drug-induced delayed rashes, drug viral interactions, and infrequently, true IgE-mediated reactions (Blumenthal et al., 2019). The literature surrounding genetics and allergic reactions is sparse, but what can be found indicates that there is no strong connection between the two. The only significant information relative to this details that patients of self-determined European ancestry report more IgE-mediated hypersensitivity reactions, with the frequency of documented drug allergy being higher in adult women of self-reported European ancestry (Blumenthal et al., 2019). Female predominance has been stable across several studies relative to antibiotic allergies. No sex effect has been demonstrated in children (Blumenthal et al., 2019). In other words, I have deduced that genetics are not responsible for the amoxicillin reaction exhibited by the boy in the scenario.
Patient Presentation, Symptoms, and Physiological Response
As mentioned previously, the patient immediately developed swelling of the tongue and lips, as well as difficulty breathing, after his initial dose of amoxicillin. Physiologically speaking, angioedema results in inflammation and increased vascular permeability (Pier & Bingemann, 2020). Angioedema can be histamine-mediated or non-histamine-mediated. In the instance of the aforementioned scenario, the patient’s presentation is consistent with histamine-mediated angioedema (Kanani et al., 2018). This type can be allergic, pseudoallergic, or idiopathic. With anaphylaxis, the process is essentially the same, but also includes bronchospasm (Pier & Bingemann, 2020). As with hypersensitivity reactions, the immune system responds in an exaggerated and inappropriate manner towards an antigen or allergen (Justiz-Vaillant & Zito, 2019); in this case, it is the amoxicillin. According to Justiz-Vaillant and Zito (2019), the cause of the hypersensitive reaction is unknown, but may be indicative of lifestyle changes, a lack of breastfeeding, and air pollution.
The Cells Involved in the Process
In type I hypersensitivity reactions, antibiotic-specific IgE in this case, binds to Fc-epsilon-RI receptors that are present on mast cells and basophils (Maker et al., 2019). Once this is done, histamine is triggered and released, along with leukotrienes and other mediators, to cause vasodilation and increased capillary permeability. Any future antibiotic exposure leads to mast cell and basophil degranulation (Maker et al., 2019). In the instance of true anaphylaxis to amoxicillin, the patient is to be directed to avoid all penicillins and beta-lactams except aztreonam until further testing can be done (cite Penicillin allergy). It is also recommended to desensitize urgently if necessary or order immediate skin-testing.
Modifying Characteristics
Regarding characteristics that would change my response to the scenario, I mentioned previously that genetic studies were more available regarding adult females. In that case, I would be more inclined to investigate the patient’s genetic history by obtaining lab values where necessary. However, the treatment plan would essentially remain the same initially, with treating the immediate problem, followed by skin-testing. I would venture to say that the results of the genetic testing could easily sway the direction of future treatment, but desensitization would still be a likely route.
References
Blumenthal, K. G., Peter, J. G., Trubiano, J. A., & Phillips, E. J. (2019). Antibiotic allergy. The Lancet, 393(10167), 183–198. https://doi.org/10.1016/s0140-6736(18)32218-9
Pier, J., & Bingemann, T. A. (2020). Urticaria, angioedema, and anaphylaxis. Pediatr Rev, 41, 283-92.
Kanani, A., Betschel, S. D., & Warrington, R. (2018). Urticaria and angioedema. Allergy, Asthma & Clinical Immunology, 14(S2). https://doi.org/10.1186/s13223-018-0288-z
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
Maker, J. H., Stroup, C. M., Huang, V., & James, S. F. (2019). Antibiotic Hypersensitivity Mechanisms. Pharmacy, 7(3), 122. https://doi.org/10.3390/pharmacy7030122
Grading Rubric Guidelines
Performance Category | 10 | 9 | 8 | 4 | 0 |
Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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Performance Category | 10 | 9 | 8 | 4 | 0 |
Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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Performance Category | 5 | 4 | 3 | 2 | 0 |
Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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0 points lost | -5 points lost | ||||
Total Participation Requirements
per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |