The Role Genetics Plays in the Disease
According to the National Institute on Drug Abuse (2019), 99.9 percent of any two people have the same DNA sequences. The 0.1 percent difference is very important because it accounts for three million differences in almost three billion base pairs of DNA sequences (National Institute on Drug Abuse, 2019). These differences are what contributes to certain diseases such as addiction (National Institute on Drug Abuse, 2019). According to the American Psychological Association (2008), genetics can play a role in addiction and at least half of a persons’ susceptibility to drug addiction can be linked to genetic factors.
NURS 6521 Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
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Why the Patient is Presenting with the Specific Symptoms Described
The patient overdosed on an opioid drug. According to Schiller et. al. (2020), when an opiate is used in large amounts the opiate pathway is stimulated. The over stimulation decreases the respiratory status of the patient (Schiller et al., 2020). Once the patient’s respiratory status decreased, he became unresponsive and laid on the floor on his left side for a period of time as evidenced by his left greater trochanter and left forearm suffering from necrosis. According to Simon et al. (2020), the blood flow was decreased, which causes a decrease in circulation, which causes a shift in potassium levels, and this causes cardiac irregularities.
The Physiologic Response to the Stimulus and Why the Response Occurred
According to Schiller et al. (2020), overdose of an opioid occurs when the patient over stimulates their opiate pathway. When the over stimulation occurs the respiratory status decreases (Schiller et al., 2020). When the opioid enters the body it goes to the synapses, then to the heart and then to the lungs (Schiller et al., 2020). In the lungs is where the blood is filled with oxygen before going back to the heart again (Schiller et al., 2020). The heart then pumps the blood to the entire body and attaches opioid receptors (Schiller et al., 2020). The heart then slows down and the opioid suppresses the neurological signal which causes oxygen levels to fall (Schiller et al., 2020). The patient then became unresponsive and laid for an unknown period of time on his left side on the floor where he was found. According to Schiller et al., (2020), the opiates act on opiate receptors in the brain which causes the mu receptor to release dopamine that blocks the signal of pain and decreases the level of consciousness. With the patient unresponsive laying in the same position on his left side without any signal of pain necrosis set in to the tissue on the left greater trochanter and left forearm. According to McCance & Huether (2019), when a cell dies it triggers an inflammatory response and plasma and protein is leaked out of the cells. This process recruits’ leukocytes in host defense and tissue repair (McCance & Huether, 2019). The patient’s blood supply was decreased to the greater trochanter and left forearm from the pressure of laying on them too long without movement. This caused the nucleus of the cells to swell. Then the plasma membrane ruptured and caused cellular and nuclear lysis and inflammation to the areas discussed. The living tissue broke down, releasing chemicals into the bloodstream and tissue damage occurred and became necrotic when the cells died.
Next the Naloxone was administered by the EMS. According to the National Institute on Drug Abuse (2018), Naloxone is an opioid antagonist and it binds to the opioid receptors. It reverses the effects of opioids and blocks them (National Institute on Drug Abuse, 2018). Normal respirations then occur in the patient and they become responsive. They then start to feel pain again as well. Once at the ED the patient was found to have an elevated serum potassium level and an EKG with a prolonged PR interval and elevated T waves. According to Simon et al., (2020), dehydration leads to hypotension and decreased tissue perfusion. Metabolic acidosis occurs next with decreased circulation of blood flow (Simon et al., 2020). Next a shift in the potassium occurs, an intracellular shift, and this causes an elevated potassium level (Simon et al., 2020). According to Yates & Manini (2012), an elevated potassium level causes a prolonged PR interval because opioids decrease sympathomimetic tone and rhythm disturbances occur due to a blockade of potassium. With the peaked T waves an ion disturbance takes place because the potassium channels are being blocked (Yates & Manini, 2012).
The Cells That Are Involved in This Process
In this scenario the blood cells are involved because of the decrease in blood circulation. The skeletal muscle cells are involved because the patient was down for a long period of time in the same position. The nerve cells are involved because the feeling of pain was decreased because the pain receptors were blocked. The skin cells are involved because of the necrosis that occurred. So many cells were involved in this overdose and the repercussions from the overdose.
How Another Characteristic Would Change My Response
I am not sure any characteristic would change my response. Characteristics such as gender, genetics, physical appearance or age would not affect my response. Whether male or female, old or young, tall or short, with an opioid overdose as in this scenario used, the results would be the same. If the scenario spoke of healing time, then my response would be different for an example. The scenario given to me, is going to be the same outcome no matter the characteristics. All bodies will respond the same way as in the scenario.
References
American Psychological Association. (2008). Genes matter in addiction. https://www.apa.org/monitor/2008/06/genes-addict
McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8thed.). St. Louis, MO: Mosby/Elsevier
National Institute on Drug Abuse. (2018). Opioid overdose reversal with Naloxone (Narcan, Evzio). https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-reversal-naloxone-narcan-evzio
National Institute on Drug Abuse. (2019). Genetics and epigenetics of addiction drug facts. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction
Schiller, E. Y., Goyal, A., Cao, F., & Mechanic, O.J. (2020). Opioid overdose. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470415/
Simon, L.V., Hashmi, M.F., & Farrell, M.W. (2020). Hyperkalemia. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470284/
Yates, C., & Manini, A. (2012).Utility of the electrocardiogram in drug overdose and poisoning: Theoretical considerations and clinical implications. https://www/ncbi.nlm.nih.gov/pmc/articles/PMC3406273/
NURS_6521_Week4_Assignment_Rubric
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Excellent |
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Fair |
Poor |
| Explain your diagnosis for the patient, including your rationale for the diagnosis. |
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
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The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.
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The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.
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The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
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| Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. |
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
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The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
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The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
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The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
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| Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. |
The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient.
The response includes specific, accurate, and detailed examples that fully support the justification provided.
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The response provides a basic justification for the recommended drug therapy plan for this patient.
The response includes only 1-2 examples that fully support the justification provided.
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The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient.
The response may include examples, which may inaccurately or vaguely support the justification provided.
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The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing.
The response does not include examples that support the justification provided, or is missing.
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Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. |
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
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Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
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Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
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Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
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Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation |
Uses correct grammar, spelling, and punctuation with no errors
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Contains a few (1–2) grammar, spelling, and punctuation errors
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Contains several (3–4) grammar, spelling, and punctuation errors
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Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
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| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. |
Uses correct APA format with no errors
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Contains a few (1–2) APA format errors
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Contains several (3–4) APA format errors
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Contains many (≥ 5) APA format errors
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