Sample Answer for NURS 6521 Week 1 Discussion Alterations in Cellular Processes Included After Question
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
A Sample Answer For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Case Scenario 1
The disease highlighted in the scenario is Tonsillitis. The 16-year-old boy complained of a sore throat for 3 days and denies fever/ chilis. He has no PMHx of recurrent colds influenza, ear infections, or pneumonia. Vital signs on physical examination were within the normal range. The HEENT was also normal except for reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy, as well as positive rapid strep test performed in the doctor’s office presents the common signs and symptoms of tonsillitis.
Tonsillitis is the inflammation of the tonsils caused by infections with a common virus or bacterial infections such as group A Streptococcus. According to Mayo Clinic (2020), the tonsils are the immune system’s first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil’s immune system function declines after puberty, a factor that may account for the rare cases of tonsillitis in adults. Tonsillitis often affects children, and tonsillitis caused by bacteria is most common in children 5 ages to mid-teenage. Inflammation of the tonsils can cause complications such as disrupted breathing during sleep (obstructive sleep apnea), an infection that spreads deep into the surrounding tissue (tonsillar cellulitis), an infection that results in a collection of pus behind a tonsil (peritonsillar abscess).
Host genetic variations play an important role in several pathogenic diseases. Therefore the genetic variations in this context of tonsillitis play an equally significant role to contribute to differences in susceptibility and clinical outcomes of invasive group A Streptococcus (Krishnan et al, 2016).
The alteration of the mast cells involved in this process, due to the inflammatory response of the phagocytic cells (neutrophils, B-cells, and T-cells extravasation) made the patient present with the specific symptoms described in the scenario (Khan Academy, 2010).
The physiologic response to the stimulus presented in the scenario is an anaphylactic response mediated by IgE antibodies that are produced by the immune system in response to the antibiotic the patient ingested. These antibodies (IgE) bind to mast cells and basophils, which contain histamine granules that are released in the reaction and cause inflammation (Justiz Vaillant &Zito, 2019). I think this response occurred because the efficacy or sensitivity of the amoxicillin was not compatible with the boy’s variant dominant genes. According to McCance & Huether (2019), Several genes are now known to be associated with sensitivity to specific therapeutic drugs, and people are sometimes tested for variants in these genes to help guide drug treatment. A patient with different characteristics of the genes without sensitivity to the amoxicillin will respond well with positive outcomes.
Reference
Khan Academy. (2010). Inflammatory Response/ Human Anatomy and Physiology/ Health & Medicine
. Retrieved from https://www.you tube .com/watch?v=FxSuEIMrPQK.
Justiz- Vaillant, A.A., and Zito, P.M. (2019). Immediate Hypersensitivity Reactions. In Statpearls. Treasure Island, FL: Statpearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315.
Krishnan, K.C., Mukundan, S., Alagarsamy, J., Laturnus, D., Kotb, M. (2016). Host Genetic Variations and Sex Differences Potentiate Predisposition, Severity, and Outcomes of Group A Streptococcus-Mediated Necrotizing Soft Tissue Infections. Iai.asm.org>content. DOI: 10.1128/IAI.01191-15.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Week 1 Discussion.
- The patient, a 16-year-old boy presents specific and severe symptoms out of allergic reaction or hypersentivity to amoxicillin that was prescribed to him. His tongue and kips have swollen and could produce wheezing that was audible as well as difficulties in the breathing process. These are common allergic responses to Amoxicillin that occur in young people especially children or those persons with allergies towards drugs such as this.
2. Physiologic responses:
People who are hypersensitive produce an antibody known as immuno globulin called Inge, on its first exposure to a given allergen. The produced antibodies bind to a type of white blood cells called basophils and mast cells that are found in the blood stream (Howard, Wiesch, Koppelman, Postma, Meyers, & Bleecker, 1999).
On the second exposure to allergens, the antigens or allergens proceed to combine with the attached antibodies and form antigen-antibody reaction. This reaction breaks the mast cells or basophils and therefore release of inflammatory mediators. An example of inflammatory mediator produced is histamine or cytokines. Due to contraction of the bronchiole’s smooth muscles, then there occurs wheezing and difficulties when breathing. Also, the effect of inflammatory mediators causes vasodilation and thus there occurs fluid leakage from the blood vessels which results to swelling and edema (Mori, Cianferoni, Barni, Pucci, Rossi, & Novembre, 2015).
Examples of the cells mainly involved in allergic reactions are mast cells, eosinophils as well as basophils. In terms of gender, the females (girls and women) are likely to suffer more from reactions resulting from allergens as compared to the boys and men who are above 18 months.
To easily diagnose allergies that result from consumption of food, a method called challenge testing is used for diagnosis. The method involves the removal of some food elements in one’s diet and for a particular period of time and then recording any symptoms when the food is eaten again.
A more scientific test for an allergy in the blood checks the blood for antibodies towards a given allergen. Antibodies refers to protein substances that are produced by the body to fight substances considered to be harmful. Blood testing method is more preferable to other tests.
Genetics: this refers to the study of transmission of different traits from the parents to the offsprings. Genetics study is useful as it helps explain the uniqueness found in family members and also explain why some diseases are likely to run in other families.
The tendency of families to develop allergic conditions is genetically linked and referred to as atopic. The children born in atopic families are susceptible to allergic reactions. As well, the children who are born in families where the parents do not have history of an allergic disease have fewer tendencies to face allergic reactions (Ballesta, 1998). However for the children born in families with history of allergic reactions, they only are susceptible to allergies other than a specific allergic condition.
These traits are most of the allergies that result from food consumption can be genetically explained. Individuals with a history of allergy are likely and prone to experience allergy. Children who are faced by allergic reactions normally follow a pattern where and undergo a series of conditions that are allergic that is known as allergic march. Other causes of allergies apart from genetics include environmental conditions and
References
Ballesta, F. (1998). Genetics and allergy. Allergologia et immunopathologia, 26(3), 83-86.
Howard, T. D., Wiesch, D. G., Koppelman, G. H., Postma, D. S., Meyers, D. A., & Bleecker, E. R. (1999). Genetics of allergy and bronchial hyperresponsiveness. Clinical & Experimental Allergy, 29, 86-89.
Mori, F., Cianferoni, A., Barni, S., Pucci, N., Rossi, M. E., & Novembre, E. (2015). Amoxicillin allergy in children: five-day drug provocation test in the diagnosis of nonimmediate reactions. The Journal of Allergy and Clinical Immunology: In Practice, 3(3), 375-380.
A Sample Answer 2 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
The boy in the scenario was being treated with amoxicillin due to his positive rapid strep test and symptoms. Common symptoms include fever, red swollen tonsils, purulent tonsils, pain when swallowing, petechiae, odynophagia, and swollen lymph nodes (CDC, 2021). His local symptoms of inflammation involve vascular changes and leakage into the tissues (McNance & Huether, 2019). The redness and swelling are due to increased blood flow to the area from vasodilation. Capillaries dilate and allow white blood cells to leak into the infected area. His pain is from the increased pressure on the tissues from the accumulation of fluids in the area. The purulent exudate is the end result of phagocytizing cells dying in the area and being eliminated through epithelial tissue in the throat. These cells have already reached maturity and cannot replicate anymore. They are also sensitive to the acidic environment of the body, so they die after performing their immunological duties (McCance & Huether, 2019). The lymphatic system is the reason for the anterior and posterior cervical adenopathy. Lymphatic channels transport body fluids from the infection site to nodules. These nodules are swollen due to fluid shifts. The nodes act as a processing center introducing the invaders to B-cells, T-cells, and macrophages that reside in the nodes (NCBI, 2021). The immune system analyses the invaders and is able to fine tune its response.
The physiologic response to the amoxicillin was a type 1 hypersensitivity response. Cells in the body saw amoxicillin as a threat and started an inflammatory immune response. It all begins with mast cells. Mast cells line skin, blood vessels, and lung tissue. They can be activated by injury, chemicals, adaptive immune responses, or recognizing molecular patterns of viruses and bacteria (McCance & Huether, 2019). Immunoglobulin E (IgE), a chemical floating in blood plasm, binds to mast cells causing the release prostaglandins, interleukins, leukotrienes, and histamine through a process called degranulation. Mast cells also release chemicals that attract neutrophils and eosinophils to sites of injury where they phagocytose foreign invaders to the body. Histamine is the most important chemical in this reaction. When it binds to the H1 receptor it causes hives, vasodilation, bronchoconstriction, hypotension, and increased mucous production. This allows phagocytes such as neutrophils, eosinophils, and dendritic cells to enter the injured area. Red blood cells (RBCs), other body fluids, along with all white blood cells pass through causing edema to the affected areas. All of this extra fluid responding to the threat caused edema to his tongue, lips, airway and increased secretion of lung tissues. This is an urgent issue as it leads to airway compromise which is life threatening.
Strep throat is seen more in children than adults, especially ages five to 15 (CDC, 2018). Crowded areas such as schools and daycare centers increase risk of transmission (CDC, 2018). As of late, the quarantine has kept children at home so this could be slowing the spread. He is on the high end of the age for those children getting strep throat, but his social situation can also influence it.
Genetic factors play a role too. Approximately ten percent of all U.S. patients report having allergies to a penicillin class antibiotic in their past (CDC, n.d.). Parents can pass down allergies through genetics (NCBI, 2014). This is why it is a good idea to have children tested for allergies when they are younger. That way severe allergic reactions can be anticipated, and life-threatening situations can be avoided.
Centers for Disease Control (CDC). (n.d.) Is it really a penicillin allergy? https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf
Centers for Disease Control (CDC). (2021, January 12) Strep throat: all you need to know. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html
Centers for Disease Control (CDC). (2018, November) Group A streptococcal (gas) disease. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
McCance, K., & Huethe, S. (2019) Pathophysiology the biologic basis for disease in adults and children (8thed.). St. Louis, MO: Elsevier
National Center for Biotechnology Information (NCBI). (2021). Adenopathy. https://www.ncbi.nlm.nih.gov/books/NBK513250/
National Center for Biotechnology. (2014) Genetics of allergic diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415518/
A Sample Answer 3 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Genetic Roles in the disease
Cystic fibrosis (CF) is an autosomal recessive genetic disease resulting from an epithelial chloride ion transport deficit (McCance & Huether (2019), affecting about 30,000 people in the US (Cystic Fibrosis Foundation, n.d). Each cell in the human body encompasses coded instructions to make proteins that determine how the body looks, matures, and functions. Every person carries two copies of the cystic fibrosis transmembrane conductance regulator (CFTCR) gene. If a person inherits one mutated copy of the CFTR they are considered a CF carrier and can pass a copy of the defective gene to their children. However, only if a child receives two mutated CFTR genes, one from each parent, can they have CF. In this scenario, it is also possible that the 23-month-old son has received a mutated CFTR gene from each parent and has CF. As a provider, I would advise the mother that if she continues to have children, each child is at risk of having CF.
Why the patient is presenting with these symptoms
The CFTCR protein is an activated chloride channel on the epithelial cells of the lining of the airways, bile duct, pancreas, sweat ducts, paranasal sinuses, and the vas deferens. When the CFTCR expression is abnormal, the individual’s ability to regulate sodium and water movement in the body is compromised, causing increased water absorption and impaired ciliary function. This compromisation can cause dehydration, viscous secretions, bacterial infections, neutrophilic inflammation, bronchiectasis, and respiratory failure. Most often, this is seen in the respiratory and gastrointestinal systems. Due to the excessive secretions of sweat, this child’s sweat tastes salty.
The CFTR dysfunction and the buildup of secretions become thick and often plugs the pancreas, causing inflammation and infections. This damage to the pancreas causes an enzyme deficiency. The depletion of these pancreatic enzymes causes malabsorption of food, negatively affecting nutrition and weight gain. Constipation or lack of stool clearing the intestines causing pain or discomfort can be causing the colic behavior.
The physiologic response to the stimulus
While the child is still hungry, the stool Is not clearing, and the child may be developing stones in the pancreatic duct, blocking the secretions from clearing, inhibiting food from digesting. This is causing the child abdominal distention, discomfort, and pain, explaining the infant’s cry.
Cells involved in this process.
CF affects the epithelial cells in the liver, pancreas, gastrointestinal tract, esophagus, sweat glands, paranasal structures, salivary glands, lungs, and reproductive tract (McCance & Huether, 2019)
How another characteristic (e.g., gender, genetics) would change your response.
CF is only obtained when the abnormal gene is inherited from the mother and the father, so gender does not change the response.
References
Cystic Fibrosis Foundation. (n.d.) Role of genetics in CF. Retrieved from https://www.cff.org/What-is-CF/Role-of-Genetics-in-CF/
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
MedlinePlus. (2020). CFTR gene. Retrieved from https://medlineplus.gov/genetics/gene/cftr
A Sample Answer 4 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
In scenario four, a 27 year old with a history of substance abuse is found unresponsive until given naloxone. In the ED, the patient is observed with necrotic tissue on his forearm and hip. Patient has a prolonged PR interval and peaked T waves with an elevated potassium level.
Gender’s role in this scenario involves how men and women metabolize and react to medications. Differences in gastric pH, pulmonary function, and dermal thickness can all play a role on the pharmacokinetic impact for each sex (Soldin & Mattison, 2009).
The 27 year old patient is presenting with a destruction of cells through necrosis due to IV drug use. The necrotic cells cause a release of potassium that is found inside the cell, resulting in the elevated potassium level. The physiologic response that is occurring due to the injection of intravenous drugs is a type III hypersensitivity reaction due to the presentation of vasculitis, serositis, and tissue damage (Justiz-Vaillant & Zito, 2019). The necrotic tissue discovered in the ED can be attributed to a result of using IV heroin. IV heroin in the femoral arteries can lead to a disruption of blood supply to the femoral head, resulting in the presented tissue necrosis (Ozkunt et al., 2015).
If the gender was changed and the 27 year old patient was a female, extra precaution should be used when selecting a medication to use. Woman patients experience overdosing more frequently than males, are more sensitive to medications due to receptor binding, and take a higher quantity of mediation (Soldin & Mattison, 2009). Along with pharmacokinetic and pharmacodynamic considerations, avoiding the use of medications that could be potentially harmful to a fetus should be avoided in females when pregnancy status is unknown.
References
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://class.content.laureate.net/f6bf9251ee3c3f606fefa59546a98a32.pdf
Ozkunt, O. Sariyilmaz, K., Sungur, M., Ilen, F., & Dikici, F. (2015). bilateral avascular necrosis of the femoral head due to the use of hearoin: A case report. International Journal of Surgery Case Reports, 136(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701818/
Soldin, O. & Mattison, D. (2009). Sex differences in pharmacokinetics and pharmacodynamics. Clinical Pharmacokinetics, 48(3).
A Sample Answer 5 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
The patient is presenting with the symptoms of burning pain over his hip and forearm because he has a pressure injury to those areas caused by the constant pressure of lying on the floor for an extended amount of time causing decreased blood flow and oxygen supply to the areas that had constant pressure applied (McCance & Heuther, 2019). The patient had impaired circulation and tissue perfusion, was immobile, was probably undernourished, and had decreased sensation due to substance abuse, all of which are risk factors for developing pressure ulcers (Grada & Phillips, 2019). Once he received naloxone, he became responsive and was able to feel pain to the areas where the pressure injuries had occurred.
The hyperkalemia was caused by a shift of potassium from the intracellular fluid to the extracellular fluid due to cell hypoxia changing the permeability of the cell membrane (McCance & Heuther, 2019). The cells involved in this process are keratinocytes, Langerhans cells, Merkel cells, macrophages, mast cells, histiocytes, and fibroblasts. If the patient was genetically predisposed to weakening skin conditions, the rate of cell death could be much faster, leading to a greater morbidity and mortality of pressure ulcers. This patient’s morbidity and mortality risk would also be increased due to his substance abuse.
References
Grada, A., & Phillips, T. J. (2019). Pressure Ulcers. Retrieved from Merck Manual: https://www.merckmanuals.com/professional/dermatologic-disorders/pressure-ulcers/pressure-ulcers
McCance, K. L., & Heuther, S. E. (2019). Pathophysiology the biologic basis for disease in adults and children(8th ed.). Elsivier, Inc.
A Sample Answer 6 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Genetics plays a great role in the pathophysiology of cystic fibrosis. The disease itself is described as a progressive, genetic disease that is associated with frequent infections of the lungs and interferes with breathing abilities of the patient (Farrell et al., 2017). It results from mutations involving the cystic fibrosis transmembrane conductance regulator (CFTR) gene (Corvol et al., 2016). This results in a dysfunctional CFTR protein (Corvol et al., 2016). The presence of a dysfunctional CFTR protein makes it impossible to move chlorides to the cell surface. The chloride is required to attract water to the cell surface, absence of which causes mucus in the lungs and other organs to become thick and sticky ((Corvol et al., 2016).
The reasons as to why the baby is presenting with the various symptoms may be described based on the pathophysiology of cystic fibrosis. In the lungs, presence of thick and sticky mucus blocks the airways and also traps bacteria that often lead to infections such as pneumonia, inflammation, respiratory failure among other complications (Cutting et al., 2019). This explains why the baby has had multiple episodes of chest congestion and once hospitalized for pneumonia. Additionally, cystic fibrosis affects the pancreas. The accumulation of mucus in the pancreas prevents the release of digestive enzymes that help in the absorption of food, resulting in malnutrition. The mucus can also block the bile ducts in the liver and result in liver disease (Cutting et al., 2019). As a result, the baby presented with a “swollen belly” and salty-tasting skin. The body initiates a number of physiologic responses to counter the effects of the disease. A good example of the physiologic response to the disease is the stimulation of the coughing reflex in which the patient presents with persistent coughing with phlegm to try and clear the mucus in the lugs.
Cystic fibrosis affects the epithelial cells lining the lungs, digestive tract, sweat glands and the genitourinary system. Inherited cystic fibrosis gene directs cells in the aforementioned organs and organ systems to produce the defective CFTR protein. Therefore, since the disease is inherited, genetics seems to play a critical role. Individuals with the disease show inheritance of two copies of the defective CF gene in which a copy is inherited from each parent. Therefore, both of the parents should have at least a copy of the gene. Therefore, carrier couples have 25 percent chance of a child being with CF, 50 percent chance the chance the child will be a carrier and 25 percent chance of the child have no trait of the disease. Therefore, the mother should be advised accordingly before conceiving another baby.
References
Corvol, H., Thompson, K. E., Tabary, O., Le Rouzic, P., & Guillot, L. (2016). Translating the
genetics of cystic fibrosis to personalized medicine. Translational research, 168, 40-49.
Cutting, G. R., Engelhardt, J., & Zeitlin, P. L. (2019). Genetics and pathophysiology of cystic
fibrosis. In Kendig’s Disorders of the Respiratory Tract in Children (pp. 757-768). Content Repository Only!. doi.10.1016/B978-0-323-44887-1.00049-3
Farrell, P. M., White, T. B., Ren, C. L., Hempstead, S. E., Accurso, F., Derichs, N., … & Sosnay,
- R. (2017). Diagnosis of cystic fibrosis: consensus guidelines from the Cystic Fibrosis Foundation. The Journal of pediatrics, 181, S4-S15. doi.10.1016/2016.09.064
A Sample Answer 7 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Explanation of Strep Throat
Strep throat is a disease caused by a bacterial infection. This bacterium is known at streptococcus or “group A strep” (CDC, 2021). As noted in scenario one, common symptoms of this disease are sore throat, swollen lymph nodes and red or white spots to the back of the throat.
Roles Genetics Play in Strep and Why the Symptoms
Genes are responsilble for the makeup of the pathogens that cause strep throat. The pathogens are the reason the individual in this scenario presented with the specific symptoms of a sore throat, swollen glands and exudate on the back of the throat. The microbes of the genus Streptococcus can release a wide variety of toxins against the defense of the human cell (Barnett et. al, 2015). This causes a decrease in the immune system and the microbes then cause an infection. Once the immune system has declined then the reported symptoms begin.
Physiological Response and Cells Involved
The physiological response to the use of the antibiotics was lip and tongue swelling, shortness of breath and wheezing. This happens when there is an exaggerated response to an antigen or allergen causing a hypersensitive reaction (Justiz-Vaillant, A. A., & Zito, P., 2019). In the scenario, the 16 year old boy experienced a type I hypersensitivity which effects the mast cells and basophils which leads to excessive production of the IgE antibody, which resulted in life threatening symptoms (Justiz-Vaillant, A. A., & Zito, P., 2019).
Barnett, T., Cole, J., Rivera-Hernandez, T., Henningham, A., Paton, J., Nizet, V., & Walker, M. (2015). Microreview: Streptococcal toxins: role in pathogenesis and disease. Cellular Microbiology 2015. doi:10.1111/cmi.12531
Centers of Disease Control and Prevention. (2021). Disease or condition of the week: Strep throat. Retrieved from https://www.cdc.gov/dotw/strepthroat/index.html
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/
A Sample Answer 8 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Substance use disorder is prevalent in the United States. In fact, in 2018, an estimated 164.8 million individuals aged 12 and above suffered from substance use and abuse (SAMHSA, 2019). Healthy people.gov (2020) defined substance abuse as a set of related conditions associated with the consumption of mind- and behavior-altering substances with adverse behavioral and health outcomes. Drug use can have a wide range of short- and long-term, direct and indirect effects. These effects often depend on the specific drug or drugs used, how they are taken, how much is taken, the person’s health, and other factors. Price (2008) said that “at least half of a person’s susceptibility to drug addiction can be linked to genetic factors.” Genetic and environmental factors induce HK2, a type of RNA virus that integrates within a gene and regulates Dopamine Dopamine production signals the brain reward systems. Thus addiction happens (Mavrikaki, 2019).
Different drugs have different effects on the brain. Some drugs affect the brain’s basal ganglia, which is otherwise known as the “pleasure center.” Over excitation of the pleasure, center causes euphoria or being high. Some drugs affect the extended amygdala, which may cause irritability, and the prefrontal cortex, which controls the impulses. The three main types of drugs are depressants, hallucinogens, and stimulants. Opioids, a powerful depressant, affect the brain stem. The brain stem is responsible for heart rate, breathing, and sleeping (National Institute on Drug Abuse, 2020).
In the scenario presented, the patient has a history of substance abuse. Although it was not identified if what type of substance the patient was consuming before and how long the patient was substance-free, it is safe to say that it interfered with the brain’s normal function upon taking the substance. Having said that, the patient manifested short-term or immediate effects that can range from changes in appetite, wakefulness, falls and fractures, changes in heart rate, blood pressure, heart attack, stroke, psychosis, overdose, and even unresponsiveness or death.
In this case scenario, EMS most probably suspected an opioid overdose on the patient hence why Naloxone was given. Naloxone is a prescription medication designed to reverse opioid overdose rapidly. Naloxone is also used to address respiratory depression and increase blood pressure in septic shock management (Lloyd,2020).
The complaints of pain, change in the patient’s EKG reading and serum potassium is most probably related to a history of drug use and administration of Naloxone. The combination of sympathetic and muscular contraction leads to vasoconstriction, micro-infarcts, skeletal muscle necrosis, and local pressure necrosis (Siddiqui et al., 2009). There was no mention of the patient falling or sustaining a fracture, but the patient was found lying on the floor. This means that I can promulgate that the complained burning pain on the left hip and forearm can possibly be from the Naloxone administered to the patient or the patient’s history of substance abuse. Patients with a history of substance abuse can suffer from an inability to metabolize nutrients like calcium, which is essential in bone and muscle growth. Changes to the muscles and kidney function can also lead to rhabdomyolysis, in which the muscles begin to break down and release toxins into the bloodstream (American Addiction Center, 2020). Drugs can interfere with potassium homeostasis by promoting transcellular potassium shift or impairing renal potassium excretion (Ben Salem et al., 2014). An increase in Potassium affects myocardial contractility, thereby prolonging of PR interval. Naloxone is never given in patients with high potassium levels as it can precipitate further arrhythmias.
References
American Addiction Center. (2020, March 17). How Substance Abuse Affects the Musculoskeletal System. Sunrise House. https://sunrisehouse.com/addiction-demographics/musculoskeletal-system/.
Ben Salem, C., ;Badreddine, A., Fathallah, N., Slim, R., & Hmouda, H. (2014, September). Drug-induced hyperkalemia. Drug safety. https://pubmed.ncbi.nlm.nih.gov/25047526/.
Healthypeople.gov. (2020, October). Substance Abuse. Substance Abuse | Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse.
Lloyd, J. (2020, February). The Clinical Use of Naloxone. https://www.fda.gov/media/92994/download.
Mavrikaki, M. (2019, January 23). Your genes and addiction. Harvard Health Blog. https://www.health.harvard.edu/blog/your-genes-and-addiction-2019012815730.
National Institute on Drug Abuse. (2020, July 10). Drugs and the Brain. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain.
Price, M. (2008, June). Genes matter in addiction. Monitor on Psychology. https://www.apa.org/monitor/2008/06/genes-addict.
SAMHSA. (2019, August). Key Substance Use and Mental Health Indicators in the … Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf.
Siddiqui, F., Slater, R., & Ashraf, S. (2009, July 30). Life threatening hyperkalemia following cocaine ingestion: a case report. Cases journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740065/#!po=16.6667.
A Sample Answer 9 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
The role of genetics in protein malnutrition
Genetics is a field in the subject of biology that deals with heredity in living organisms. Genes describe the origin of something (McCance and Huether, 2019). For example, in human beings, the genetic makeup consists of male and female chromosomes that combine. The 83-year-old resident who has been residing in the facility presents with symptoms that can be explained genetically. It is possible that the problem of protein malnutrition affecting the patient could be a result of genetic makeup. It could be that one of the family members had the issue of malabsorption syndrome.
Reasons for the patient presenting with the specific symptoms
There are various reasons that explain the presentation of symptoms at the emergency department. The generalized edema of the extremities and abdomen could be a result of the problem of nutrition absorption. The external part of the stomach is an indicator of intestinal problems. The emergency department staff also indicated that the 83-year-old patient was weak. This could be attributed to the lack of eating. It was reported that the client had difficulties in consuming food because she did not have dentures. The component used to hold teeth together should be replaced to allow the patient to eat normally.
The physiological response to the stimulus presented in this scenario
The way a human body functions or living organisms operate describes their physiology (Vaillant et al, 2019). Individuals respond differently to the same stimuli. In this scenario, the body of the 83-year-old patient responded to the stimuli in various ways. The swollen part in his stomach could be a stimulus-response to the malabsorption syndrome. I think people who present with edema in their body parts are a physiological reaction to an internal injury or malfunction. I also believe that the difficulty in eating could be as a result of problems in the stomach. Protein malnutrition could be manifested in different ways.
The cells involved in this process
The human body consists of different building blocks that provide the structure (Miller and Zachary, 2017). The cells involved in the physiological responses for the 83-year-old patient are many. For example, the cells that take part in the extraction of nutrients from foods and converting the same to energy. I believe that the muscle, blood, and nerve cells of the stomach could be attributed to the problems facing the 83-year-old patient. She seems to be suffering from malfunctions in the intestinal part. As a mental health nurse dealing with adults with behavioral issues, I think the nerve cells in the stomach could have affected the eating habits of the patient.
Considerations of other characteristics
Despite the physiological responses as a result of the genetic makeup, it is possible that other variables such as gender and age would play a role in the symptoms presented. The fact that the patient is eighty-three years could be associated with the problems experienced. The immune system tends to go down as human beings age. The functionality of cells tends to reduce with the age. Another characteristic that may change the way the patient responded is the environment. The client had been staying in the hospital for a while. I am a mental health nurse who deals with people with disabilities and other behavioral issues. The psychological and mental state of the client could have been compromised.
References
McCance, K. L., and Huether, S. E. (2019). Pathophysiology: The Biologic Basis for Disease in
Adults and Children 8th Edition. St. Loius, MO: Mosby.
Miller, M. A., and Zachary, J. F. (2017). Mechanisms and Morphology of Cellular Injury,
Adaptation, and Death. Pathologic Basis of Veterinary Disease. 2017: 2–43.e19.
Vaillant, A. J. et al. (2019). Immediate Hypersensitivity Reactions. Treasure Island (FL):
StatPearls Publishing.
A Sample Answer 10 For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Introduction
Malabsorption syndrome is a disorder that occurs when the small intestine is unable to absorb fluid and nutrients such as proteins, carbohydrates, fats, vitamins and minerals. The normal mechanism of the gastrointestinal tract is to absorb nutrients from food that we eat. In this case study, the residents is noted to have difficulty eating secondary to lack of dentures which indicates that she is feeding inadequately. The malabsorption is also a cause of protein malnutrition. Protein is known to be one of the most important nutrients needed to build muscle and tissues, promote wound healing, produce new cells, regulate hormone and promote immune function.
Role of genetics in disease
Malabsorption syndrome can be genetic in nature especially with individuals that have a family history of cystic fibrosis and celiac disease. Cystic fibrosis is an autosomal recessive mutation of CTFR gene. The affected individual typically inherits one abnormal gene from each parent to end up with homologous defected genes which are required for the disease to manifest. In cystic fibrosis, the cells that produce digestive enzymes are damaged due to the build up of thick, sticky mucus that clogs the pancreatic duct. Celiac disease is another genetic disease that causes malabsorption. It occurs due to hypersensitivity reaction to gluten which is a protein found in wheat, rye and barley.
Reason for patient presenting symptoms
In this case study, we know that the resident was diagnosed with protein malnutrition secondary to malabsorption. Protein is used for tissue repair, muscle growth and immune function enhancement and it is also responsible for the oncotic pressure in the intravascular compartment. The resident presented to the emergency department with generalized edema of the lower extremities and abdomen. This is due reduced oncotic pressure secondary to hypoalbuminemia. The reduced oncotic pressure causes unopposed hydrostatic pressure driven escape of fluid into the interstitium and its subsequent accumulation there. We have to understand that the hydrostatic forces and oncotic forces counteract each other in the intravascular system. Hydrostatic pressure favors fluid escape into the interstitium while oncotic pressure opposes it. When there is a reduction in either of these forces, the other one predominates and alters the natural physiological balance.
Physiologic response to the stimulus presented and why the response occurred
The protein malnutrition will result in hypoproteinemia which will cause increased catabolism of structural proteins in the body to replace the low serum albumins resulting in a negative nitrogen balance. Also, the hypoalbuminemia causes a reduction in the oncotic pressure within the intravascular environment and fluid escape. This shrinks the intravascular volume and stimulates the renin aldosterone angiotensin system RAAS. The renin aldosterone system is stimulated by hypovolemia and hyponatremia. Hypovolemia due to reduced oncotic pressure and escape of intravascular fluid into the interstitium results in Angiotensinogen which is produced in the liver is converted to angiotensin 1 by renin which is produced in the juxtaglomerular apparatus in the kidneys. Angiotensin1 is then converted to angiotensin 2 by angiotensin converting enzymes which are produced in the lungs. Angiotensin 2 does various things that help to physiologically compensate for the reduced intravascular volume and pressure. The functions of angiotensin 2 include stimulation of thirst to increase fluid intake, stimulation of aldosterone to increase fluid and salt reabsorption by the kidneys and vasoconstriction of blood vessels to increase the blood pressure.
The Cells Involved in the Process
Malabsorption occurs as a result of the inability of the small intestine to adequately absorb nutrients from ingested and food items. The small intestinal epithelium has villi which are help to digest as well as increase the surface area for absorption of food. The epithelial cells are destroyed by autoantibodies in celiac disease therefore impairing food absorption. Loss of segments of the small intestine due to surgery also causes malabsorption. Other cells that may be involved in malabsorption include gastric mucosa cells, pancreatic acini cells which are affected in chronic pancreatitis and cystic fibrosis.
How Genetics and Gender will Change Response
Some of the causes of malabsorption syndrome are caused by inheritable genetic defects. For example, cystic fibrosis is an autosomal recessive condition. Autosomal recessive conditions can be avoided by phenotypically by ensuring that carriers of the defect do not marry other carriers. Some of the causes of malabsorption syndrome also have more serious presentations in certain genders. For example, celiac disease as with most autoimmune diseases are more severe in women. Cystic fibrosis on the other hand has no gender prevalence due to its autosomal inheritance.
References
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Roumelioti, M. E., Glew, R. H., Khitan, Z. J., Rondon-Berrios, H., Argyropoulos, C. P., Malhotra, D., Raj, D. S., Agaba, E. I., Rohrscheib, M., Murata, G. H., Shapiro, J. I., & Tzamaloukas, A. H. (2018). Fluid balance concepts in medicine: Principles and practice. World journal of nephrology, 7(1), 1–28. https://doi.org/10.5527/wjn.v7.i1.1
Sattar HA. Fundamentals of pathology: medical course and Step 1 review. Chicago, IL: Pathoma.com; 2019.
A Sample Answer For the Assignment: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
Title: NURS 6521 Week 1 Discussion Alterations in Cellular Processes
A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction
Role Genetics Play in Disease
The patient is negative for recurrent colds, influenza, ear infections or pneumonia which shows that genetics did not have an impact on the patient being positive for strep throat. Genetics can play a role in recurrent infections. According Burgner et al. (2006), susceptibility to infection and many other human diseases arises from the complex interaction of environmental and host genetic factors (p. 653). Recurrent infection by pyogenic bacteria suggests a defect in antibody, complement, or phagocyte function, reflecting the role of these parts of the immune system in host defense against such infection (Janeway et al., 2001). Patients may have genetic factors that impact the immune response to certain diseases. Infectious diseases, like other phenotypes, may exhibit familial aggregation: a greater frequency of the disease in relatives of infected individuals compared with relatives of those without disease (Burgner et al., 2006, p. 654). Though genetics can play a role in recurrent infections, that was not the case for this patient and his strep throat appears to be acute rather than chronic.
Why the patient is presenting with the specific symptoms described
The patient’s immunologic response to strep throat which included low grade temperature of 99.6, reddened posterior pharynx with white exudate on +3 enlarged tonsils, and anterior and posterior cervical adenopathy where all the patient’s immunologic response to disease rather than the patient’s genetics. Strep throat is not a genetic disease, it is a bacterial disease. Streptococcus pyogenes is transmitted via respiratory droplets or skin contact with carriers or their environment (Peter et al., 2017, p. 730). The patient’s symptoms were all a response to strep throat. After a person is infected with strep through, they go through a short incubation period, fever and sore throat develop, with an erythematous pharynx, cervical lymphadenopathy and tonsillar enlargement (Peters et al., 2017, p. 731). Streptococcus pyogenes causes overproduction of SAg-activated T cells which cause fever and inflammation (McCance and Huether, 2019, p. 245). The patient also presents with reddened pharynx with white exudate which are all a response to the patient’s immune system. The second line of defense is the inflammatory response which protect the body from further injury (McCance and Huether, 2019, p. 191). The patient also white exudate which is part of the inflammatory response in early or mild inflammation with very few plasma proteins or leukocytes (McCance and Huether, 2019, p. 210). So, the redness in the pharynx, the white exudate, and the enlarged tonsils are all a reaction to inflammation in the throat related to the introduction of the bacteria Streptococcus group A.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred
Once the patient tested positive for strep throat, he was given the antibiotic Amoxicillin. Patient took the medication and immediately had an allergic reaction. The fact that the patient had a reaction within minutes this showed that the patient had an immediate hypersensitivity reaction (McCance and Huether, 2019, p. 256). The patient’s allergic reaction included swelling, difficulty breathing, and wheezing which are all signs of an anaphylaxis reaction. The most rapid and severe immediate hypersensitivity reaction is anaphylaxis (McCance and Huether, 2019, p. 256). This type of reaction usually occurs immediately after being exposed to a substance that a patient is allergic to. Symptoms of systemic anaphylaxis include difficulty breathing and contraction of bronchial smooth muscle which can be the reason the patient was wheezing (McCance and Huether, 2019, p. 256). The patients swollen lips and tongue were caused by cutaneous anaphylaxis which results in local symptoms such as swelling (McCance and Huether, 2019, p. 256).
The cells that are involved in this process
The cells involved in the patient developing an allergic reaction are mediated by antigen specific IgE and the products of the tissue mast cells (McCance and Huether, 2019, 256). The patient cells quickly reacted to the Amoxicillin. The patient having immediate swelling of the lips and tongue is due to the products of mast cell degranulation which happens due to an acute inflammatory response (McCance and Huether, 2019, p. 256). The patient also having immediate difficulty breathing and audible wheezing which were caused by bronchial constriction. The most potent mediator is histamine which impacts target cells acting through the H1 receptors which can cause bronchial constriction (McCance and Huether, 2019, p. 256). Type II allergic hypersensitivities are usually against allergic happens that bind to the surface of the cells and elicit an IgG or IgM response which happens with many drugs like penicillin’s (McCance and Huether, 2019, p. 266). Amoxicillin is in the same drug class of penicillin. In allergic reactions to penicillin, the immunogenic antigen is a metabolite of penicillin catabolism that binds to the plasma membranes of erythrocytes or platelets and induces an antibody response that destroys cells (McCance and Huether, 2019, p. 266).
How another characteristic (e.g., gender, genetics) would change your response
Many characteristics of the patient could change the response. The patient was a 16-year-old male which in this age group it is common for them to have strep throat. If the patient was a newborn or an elderly patient this could impact how their immune system may react to the bacteria. Also, if the patient was immunodeficient this would also change his course of treatment because he may need a more aggressive approach. If the patient had any genetic dispositions that would put him at higher risk for infection would also change the type of care given to the patient. If the patient has used several antibiotics due to recurrent infections this would help me to identify an appropriate antibiotic to prevent MRSA. If the patient had a history of hypersensitivity to antibiotics this would have also changed the course of his treatment. Gender would not impact the change in response to a bacterial infection, but it would help me look out for different side effects from antibiotics like yeast infections.
References
Burgner, D., Jamieson, S. E., & Blackwell, J. M. (2006). Genetic susceptibility to infectious diseases: Big is beautiful, but will bigger be even better? The Lancet Infectious Diseases, 6(10), 653-663. doi:10.1016/s1473-3099(06)70601-6
Janeway, C., A., Shlomchik, M., J., Travers, P., Walport, M. (2001). Immunobiology, 5th edition: The Immune System in Health and Disease. Garland Publishing.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Peters, J., Price, J., & Llewelyn, M. (2017). Staphylococcal and streptococcal infections. Medicine, 45(12), 727-734. doi:10.1016/j.mpmed.2017.09.010