NURS-6501 Advanced Pathophysiology week 1 discussion-ALTERATIONS IN CELLULAR PROCESSES

NURS-6501 Advanced Pathophysiology week 1 discussion-ALTERATIONS IN CELLULAR PROCESSES

Case Scenario

The essential component of the case study is substance abuse and the patient’s response to an opioid overdose reversal agent. The patient’s response to Naloxone is a clear indication of opioid overdose. Evaluation in the ED and diagnostic studies revealed a large amount of necrotic tissue over the greater trochanter and the forearm, increased potassium levels, and prolonged PR interval with picked T wave. Combining all subjective and objective data led me to a diagnosis of possible rhabdomyolysis (Torres et al., 2015).

The role genetics plays in the disease.

The chance of acquiring a common disease is often influenced by a combination of genetic and non-genetic variables; When a genetic predisposition interacts with an environmental element, the possibility of developing a disease can become considerably higher than it would if either component were acting alone (Ducci & Goldman, 2012). Although there was a hypothesis that genetics contribute to addiction, no specific blood test currently exists to identify why some people develop habits, and others do not. According to researchers, the elements that predispose people to addiction are exposure, life events, and genetic risk factors (Swart, 2017).

Why the patient is presenting with the specific symptoms described.

The prolonged PR interval and elevated T waves show hyperkalemia. Several causes mentioned in the case study can be linked to hyperkalemia. First, the acidosis brought on by the overdose and the physical modifications brought on by lying still for an unknown period. Then the trauma thought to have occurred during the overdose and immobility. The diagnosis of rhabdomyolysis is made possible by the necrosis across the left hip and forearm.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The physiological reactions might include being unresponsive and experiencing forearm and greater trochanter burning. It may be inferred from the EKG and the patient’s increased potassium levels that they have hyperkalemia. This condition is known as hyperkalemia when your body has higher-than-normal potassium levels. Through early depolarization of the cell membrane, slowed cardiac conduction, and shortening of the action potential, hyperkalemia causes cardiotoxicity. T waves are seen when a patient’s potassium level climbs after initially peaking. Then the PR interval lengthens, and the QRS lengthens (Lehnhof et al., 2016).

The cells that are involved in this process.

When a patient is discovered comatose and immobilized for an extended time due to a drug or alcohol overdose, rhabdomyolysis or myoglobinuria is suspected (McCance & Huether, 2018). The case scenario’s risk factors for rhabdomyolysis include trauma, immobilization, and indirect muscle injury from the medicine that produced the overdose.

How another characteristic (e.g., gender, genetics) would change your response.

Based on this patient’s markers, my response wouldn’t change. If someone were to be unresponsive on the floor in this way, they would all be at risk of suffering from cell death, necrosis, or rhabdomyolysis. However, if something like substance abuse were to be taken out of the picture, the onset of rhabdomyolysis may manifest differently or not at all. Unspecific symptoms of fever, malaise, anorexia, nausea, and vomiting, as well as swollen and sore muscles, paranesthesia in the limbs from compartment syndrome, or muscular discomfort, might be the presentation. Elderly individuals may exhibit disorientation, agitation, and delirium. They may also be clinically dehydrated and anuric, have myalgia and muscular weakness, and have tea-colored urine. The symptoms might be caused by releasing intracellular electrolytes, which could be deadly. Other symptoms could include heart block, ventricular tachycardia, asystole, elevated potassium ions, tetany, or disseminated intravascular coagulation (Henderson, 2015). This would require a precise diagnosis and course of action.

References

Ducci, F., & Goldman, D. (2012, June). The genetic basis of addictive disorders. The Psychiatric clinics of North America. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506170/Links to an external site.

Lehnhof, B., Bergeson, A., Durfey, S., McAteer, K., Valiquet, J., & Durfey, N. (2016). Electrocardiographic Manifestations and Clinical Outcomes of Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-Term Adverse Events? Lehnhof Research Paper: https://scholar.google.com/scholarq=Electrocardiographic+Manifestations+and+Clinical+Outcomes+of+Severe+Hyperkalemia:&hl=en&as_sdt=0&as_vis=1&oi=scholarLinks to an external site.

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.).

Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: pathogenesis, diagnosis, and treatment. The Ochsner journal, 15(1), 58–69.

Week 1 Discussion: Cellular processes and genetic environment

The role genetics plays in the disease

Genetics plays a significant role in several diseases in the human life cycle. A condition like substance abuse can be inherited from one’s parent to the offspring. Genes are the functional units that make up the human genome ( NIDA, 2019). They provide us with pieces of information that allow for the body’s basic cellular activities. In trying to understand the role of genes in substance abuse, I stumbled across research that states that genetic influences are implicated in multiple aspects of substance involvement, including predispositions to drug-seeking behavior and the development of physiological dependence. These influences likely occur through numerous mechanisms, ranging from cellular processes from metabolic and pharmacologic to psychological ( Prescott, 2006).

Why is the patient presenting with the specific symptoms described?

The patient has a history of substance abuse, he was found unresponsive by EMS, and his roommate did not know how long he had been lying on the floor. With the information provided, pt overdosed from an unknown substance. He was responsive after naloxone was administered. This reversal drug is an opioid antagonist that attaches to opioid receptors to reverse the effects of opioids ( NIDA, 2022). The reversal of opioids when a patient is unresponsive restores breathing and consciousness. This medication only works when someone has used any opioids. Secondly, after the patient became responsive, he complained about burning pain over his left hip and forearm. This could be due to laying in the same position over a long period, causing him to have necrotic tissue due to trauma-related cellular damage.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

This patient is experiencing rhabdomyolysis. Rhabdomyolysis is the rapid breakdown in muscles causing the release of intracellular contents (McCance & Huether,2019); the decrease in blood circulation from lying unresponsive is due to a low level of ATP production. Because ATP is the cell’s energy powerhouse, low ATP production can degrade the muscle cell function causing a failure of the sodium-potassium pump and sodium calcium pump, which leads to electrolytes leaking into ECF. This causes the patient to be hyperkalemic, leading to prolonged PR interval and peaked T waves.

I do not think my response to this situation will change at all in terms of gender or genetics; however, age would make a difference because older people have a decreased ability to metabolize drugs (Addiction, 2022). They are more susceptible to the detrotiating effects of these substances.

References

Addiction in the elderly. Addiction Center. (2022, August 4). Retrieved November 28,

2022, from https://www.addictioncenter.com/addiction/elderly/

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for

disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

NIDA. 2022, January 11. Naloxone DrugFacts. Retrieved from

https://nida.nih.gov/publications/drugfacts/naloxone on 2022, November 28

NIDA. 2019, August 5. Genetics and Epigenetics of Addiction DrugFacts. Retrieved

from https://nida.nih.gov/publications/drugfacts/genetics-epigenetics-addiction on

2022, November 28

Prescott, C.(2006). Retrieved November, 2022. Genetic Risk for Substance Abuse and

Addiction: Family and Twin Studies. Retrieved from

https://doi.org/10.1038/npg.els.0005230.

Savage, S. R., Kirsh, K. L., & Passik, S. D. (2008). Challenges in Using Opioids to Treat

Pain in Persons With Substance Use Disorders. Addiction Science & Clinical

Practice, 4(2), 4-25. https://doi.org/10.1151/ascp08424

NURS-6501 Advanced Pathophysiology week 1 discussion-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.

NURS-6501 Advanced Pathophysiology week 1 discussion-ALTERATIONS IN CELLULAR PROCESSES

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation: