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Scenario 3: An 83-year-old with Generalized Edema of Extremities and Abdomen

Scenario 3: An 83-year-old with Generalized Edema of Extremities and Abdomen

 

Scenario 3: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

Discussion: Alterations in Cellular Processes

Photo Credit: Getty Images

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

 

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

 

What’s Coming Up in Week 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will examine alterations in the immune system and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, that may impact altered physiology.

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .

For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.

Please take the time to review the Appropriate Preceptors and Field Sites for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.

Next Week

 

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Scenario 3: An 83-year-old with Generalized Edema of Extremities and Abdomen

 

Scenario 3: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of

Scenario 3 An 83-year-old with Generalized Edema of Extremities and Abdomen

Scenario 3 An 83-year-old with Generalized Edema of Extremities and Abdomen

extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

 

  1. The role genetics plays in the disease. Some genetic factors that can play a part in malabsorption syndrome involve conditions that hinder digestion. These include chronic pancreatitis, Celiac disease, Crohn’s disease, and hereditary folate malabsorption. These genetic diseases cause an inflammatory process in certain parts of the Gi tract resulting in malabsorption of essential nutrients (Medline Plus, 2020).

 

  1. Why the patient is presenting with the specific symptoms described. The patient presents with protein malnutrition characterized by an energy-deficient state caused by deficiencies of fat, carbohydrates, and protein, also known as macronutrients. The patient has a history of malabsorption syndrome, so the patient has difficulty absorbing protein. Their inadequate oral intake exacerbates the condition due to difficulty eating secondary to a lack of dentures.

Elderly individuals with chewing difficulties risk weight loss, poor nutrition, and increased mortality due to insufficient nutrition intake. Proper chewing of food is essential for adequate absorption of certain nutrients, primarily more substantial proteins (Keller & Layer, 2014). The patient’s poor nutrition results in a deficiency or low protein levels in the blood, causing abdominal edema similar to kwashiorkor’s extreme case.

 

  1. The physiologic response to the stimulus presented in the scenario and why you think this response occurred. Due to protein deficiency or starvation, muscles start to atrophy leading to protein degradation (McCance & Huether, 2019). Albumin synthesis is decreased due to protein deficiency. Albumin plays a significant role in maintaining oncotic pressures within the blood vessels. Low albumin levels within the lumen allow for interstitial leakage of fluid, as presented by increased edema (Gounden, Vashisht, & Jialal, 2020).

 

  1. The cells that are involved in this process. Immune cells are closely linked to metabolic changes caused by malnutrition. Malnutrition will influence cytokine levels, immune cell counts, and their effectiveness. Protein malnutrition diminishes the functionality of T-cells, neutrophils, and natural killer cells (McCance & Huether, 2019). There will also be a change in hormone activity and albumin levels.

 

  1. How another characteristic (e.g., gender, genetics) would change your response. Insufficient enzyme production diseases can affect the absorption of macronutrients, including protein. Individuals who have pancreatic cancers, Crohn’s, inflammatory bowel diseases, and diabetes are some examples that can disturb the exocrine pancreas functions, which can worsen these physiological responses (Keller and Layer, 2014). Individuals with organ failure or deficiencies bring on higher demand for nutrients. This demand exacerbates the energy deficit compared to nutritional intake. Hypermetabolic conditions increase energy expenditure on the body and worsen the malabsorption physiology (Saunders & Smith, 2010).

 

References

Gounden, V., Vashisht, R., & Jialal, I. (2020). Hypoalbuminemia. StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526080/

Keller, J., & Layer, P. (2014). The Pathophysiology of Malabsorption. Viszeralmedizin, 30(3), 150–154. https://doi.org/10.1159/000364794

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Medline Plus. (2020). Malabsorption Syndromes. https://medlineplus.gov/malabsorptionsyndromes.html

Saunders, J., & Smith, T. (2010). Malnutrition: causes and consequences. Clinical medicine (London, England), 10(6), 624–627. https://doi.org/10.7861/clinmedicine.10-6-624

Discussion: Alteration in Cellular Processes

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Initial Post

Malnutrition has been in existence for ages throughout the world but varies in different countries like the third world countries and the United States of America. Malnutrition is rampant in children, but there are higher cases found in the elderly in the United States (U.S.). Symptoms are not often noticed due to minor signs and inability to recognize the symptoms, which is most commonly attributed to aging (Alliance for Aging Research, 2016.).

This discussion will be based on a brief scenario of an 83-year-old who presented with generalized edema of extremities and abdomen. This patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient is diagnosed with Protein Malnutrition. Also, this disease will be examined thoroughly, followed by reviewing symptoms presented, the cells responsible for the illness, and the possible variation and effects of protein malnutrition.

Role Genetics Plays in the Disease

As deoxyribonucleic (DNA) is formed and reproduced inside the cell of the nucleus, protein forms in the cytoplasm have two phases known as transcription and translation with the intervention of ribonucleic acid (RNA) (McCance & Huether, 2019.). Transcription is formed from the synthesized RNA and acts as an RNA messenger. This occurs when RNA polymerase, an enzyme, bonds to a proponent area of the DNA, forming a gene (McCance & Huether, 2019.). Also, another protein named transcription factor binding sites originated from the DNA segment that regulates specific genes for transcription and in charge of the timing of transcription. Transcription can create or inhibit genes and is often improved by enhancers (McCance & Huether, 2019.). The RNA polymerase creates mRNA nucleotides by extracting a part of DNA strands from another DNA, thus guides the cycle of mRNA nucleotides. Transcriptions terminate once the DNA cycle called termination sequence is achieved.

Consequently, the RNA polymerase separates from the DNA, causing the transcribed mRNA to ravel out of the nucleus into the cytoplasm (McCance & Huether, 2019.). The second step is the translation which entails the migration from a gene to forming a protein in the cytoplasm. Translation communicates with transfer RNA (tRNA) for amino acids, as tRNA has space to accommodate amino acids (McCance & Huether, 2019.). Anticodon, a combination of three nucleotides, pairs the correct codon in the mRNA, and the mRNA defines the order of amino acids with the aid of tRNA. There is a communication process of amino acid translation as mRNA and tRNA interact with each other when a codon is formed with ribosomes’ help in the cytoplasm. A bond is created next to amino acids that produce polypeptide (McCance & Huether, 2019.). At the terminal stage, the ribosome notifies the mRNA sequence, translation, and polypeptide growth to quit. They all separate from each other, but the polypeptide is moved into the cytoplasm to perform its responsibility (McCance & Huether, 2019.).

Reasons for Patient’s Specific Symptoms

Protein deficiency leads to intestinal mucosal accumulation. Therefore, it reduces the rate of absorption and reduces its performance. Low levels of protein in the blood constitute protein malnutrition (McConnell, 2014.). Also, low albumin level leads to reduced intravascular osmotic pressure, leading to retention of fluid from the extravascular pressure, which brings about the patient’s symptoms of tissue edema and ascites (McConnell, 2014.).

The Physiologic Response to the Stimulus and Why the Response Occurred

A decreased plasma oncotic pressure is due to loss of albumin production. Fluid in the capillary escapes into the interstitial space and causes edema of the extremities. The combination of a decreased composite of plasma protein and reduced osmotic pressure leads to this patient’s diagnosis of protein malnutrition (McCance & Huether, 2019). Increased capillary permeability is another physiologic response in which an excessive amount of fluids leave the plasma for the interstitial space and cause swelling, as seen in the patient’s symptoms. This is a difficult situation due to protein loss from the vascular area, which causes decreased osmotic pressure and a fluid increase in the interstitial oncotic pressure, which simultaneously enables free fluids to go into the interstitial space (McCance & Huether, 2019. The patient’s physiologic response of localized edema of the abdomen, as there is an excess accumulation of fluid in the abdomen (McCance & Huether, 2019.

Cells Involved in this Process

Cells have their different specializations via differentiation or based on their maturity. Cells perform in diverse ways and are responsible for muscle movement, conductivity, mechanical absorption, secretion, excretion, respiration, reproduction, and communication (McCance & Huether, 2019.

In this scenario, cells that are involved in metabolic absorption will be the focus of this section. Cells perform well when the appropriate nutrients surround them, and cells in the intestine and kidney are responsible for absorption and re-absorption of fluids and synthesize protein. Majorly, cells from the intestinal epithelial carry out the best responsibility of reabsorbing fluids and protein enzymes (McCance & Huether, 2019. The endoplasmic reticulum (ER) synthesizes and moves protein and lipid constituents of cell organelles (McCance & Huether, 2019.

How Gender Changed My Response

There are some variations when it comes to differences in gender and race in protein levels. In this section, a comparison of c-reactiveprotein (CRP)

will be discussed. Based on research, blacks tend to have higher CRP levels while whites present with lower CRP levels. Also,women tend to have a

higher CRP level than men (Khera et al., 2005). This is interesting to know that protein malnutrition is more significantor more prominent in race and

gender. This may be considered essential to add as part of assessment tools for providers

References

Alliance for Aging Research. (2016). Malnutrition: Healthcare Professional Tip Sheet. Retrieved March 2, 2021, from

https://www.agingresearch.org/app/uploads/2017/12/AAR20Malnutrition20Tip20Sheet2072014.pdf

Khera A, McGuire D. K., Murphy S. A., Stanek H. G., Das S. R, Vongpatanasin W., Wians F. H. Jr., Grundy S. M, & De Lemos J. A. (2005). Race and gender differences in C-reactive protein levels. Journal of the American College of Cardiology (JACC), 46(3), 464–469. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jacc.2005.04.051

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

McConnell, T.H. (2014). The Nature of Disease: Pathology for the health professions (2nd ed.). Baltimore, MD: Wolters Kluwer/Lippincott Williams & Williams

 

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