NURS 6051 Discussion: Alterations in Cellular Processes

A Sample Answer For the Assignment: NURS 6051 Discussion: Alterations in Cellular Processes

Title: NURS 6051 Discussion: Alterations in Cellular Processes

In this scenario, an 83-year-old resident of a skilled nursing facility presents at the emergency department with generalized edema of the extremities and abdomen. History reveals a diagnosis of malabsorption syndrome and difficulty eating due to a lack of dentures, resulting in protein malnutrition (Clark & Johnson, 2018; McCance & Huether, 2019). The patient’s presentation of generalized edema is a classic symptom of protein malnutrition, where a deficiency in plasma proteins, particularly albumin, leads to decreased oncotic pressure and subsequent fluid accumulation in the interstitial spaces, causing edema (McCance & Huether, 2019). Malabsorption syndrome exacerbates malnutrition, amplifying the severity of the symptoms.

Physiologically, the body responds to protein malnutrition by initiating adaptive mechanisms to maintain homeostasis. Decreased protein intake and hypoalbuminemia trigger increased protein breakdown, decreased synthesis, and altered fluid balance to prioritize essential functions (McCance & Huether, 2019), leading to fluid retention as a compensatory mechanism for decreased intravascular oncotic pressure. Cells involved in the process of protein malnutrition include hepatocytes in the liver, responsible for synthesizing acute-phase proteins, and skeletal muscle cells, undergoing proteolysis to release amino acids for energy production (Deutz et al., 2014). Hepatocytes also produce albumin, and decreased synthesis due to malnutrition contributes to hypoalbuminemia, while endothelial cells lining blood vessels regulate fluid balance, with their permeability altered in response to hypoalbuminemia, leading to fluid extravasation and edema formation (McCance & Huether, 2019).

If the patient’s race were identified as African American, it might influence characteristics related to healthcare disparities and cultural considerations. For example, studies have shown that African American older adults are at higher risk of malnutrition due to socioeconomic factors, access to healthcare, and cultural dietary preferences (Sheean et al., 2019).

In conclusion, the 83-year-old female patient presenting with generalized edema due to protein malnutrition highlights the importance of early identification and intervention in addressing nutritional deficiencies in older adults, particularly those residing in skilled nursing facilities.

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NURS 6051 Discussion: Alterations in Cellular Processes

NURS 6051 Discussion Alterations in Cellular Processes

Scenario

A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. The patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L.

Genetic Role

By simultaneously examining a person’s entire genome, recent advancements in DNA analysis are assisting researchers in unraveling intricate genetic interactions. Advancements, for example, genome-wide association studies (GWAS), entire genome sequencing, and exome sequencing (taking a gander at simply the protein-coding qualities) distinguish unobtrusive varieties in DNA grouping called single-nucleotide polymorphisms (SNPs) (NIDA, 2019).

People’s responses to various medications, the rate at which their bodies metabolize drugs, and the number and variety of receptors in their brains are all influenced by their genes. The science of addiction will eventually advance if we learn more about the genetic, epigenetic, and neurobiological causes of addiction (NIDA, 2019).

Symptom Rationality/ Physiologic Response/Cells Involved

The patient was nonresponsive due to excessive substances being introduced to his body. Naloxone is a drug that quickly reverses the effects of an opioid overdose. It is an antagonist of opioids. This indicates that it binds to opioid receptors, reverses, or prevents the effects of other opioids, and so on (NIDA, 01/2022).  Overdosing causes respiratory depression and, ultimately, death due to an excessive effect on the part of the brain that controls the breathing rate. The regular side effects are pinpoint pupils, decreased respiratory capacity, and a diminished degree of cognizance (NIDA, 9/19/2022).

The patient probably had a fall when becoming nonresponsive. A medical condition known as necrotic tissue occurs when an organ in your body contains dead cells. The passing of the cells occurs because of the absence of oxygen and hindered blood supply. Necrotic tissue is the aftereffect of skin corruption. Autolysis—the self-digestion of cells following the release of enzymes—causes necrosis, which is the premature death of cells. These cells are a component of the skin’s living tissue. Necrosis can occur from an external injury or trauma (Medanta, 2023). By traumatizing cell membranes, tissue damage can also result in a shift of potassium from the inside to the outside of cells. Hyperkalemia as a result of tissue damage can result from any severe trauma, burns, surgery, rapid destruction of tumor cells, hemolytic anemia, or rhabdomyolysis—the breakdown of muscle cells that can result from heat stroke or a stupor caused by alcohol or drugs (Fogoros, 2021). ECG changes such as a peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration may result from progressive hyperkalemia. Additionally, hypokalemia may be associated with a prominent U wave, shallow T wave, peaked P wave, prolonged PR interval, and ST depression (Teymouri et. al., 2022).

Characteristic involvement

Men are more probable than women to utilize practically a wide range of unlawful drugs, and illegal medication use is bound to bring about emergency room visits or overdose for men than for women. Women are just as likely as men to develop a substance use disorder, but men have higher rates of use or dependence on illicit drugs and alcohol across most age groups. Research has shown that women frequently use medicates unexpectedly and can have exceptional hindrances to powerful treatment as basic as not having the option to find care for children or being recommended treatment that has not been tried enough on women (NIDA, 05/04/2022).

References

National Institute on Drug Abuse (NIDA). 08/05/2019. Genetics and Epigenetics of Addiction DrugFacts. Retrieved 5/30/2023 from:

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

Links to an external site.

National Institute on Drug Abuse (NIDA). (01/2022). What is Naloxone? Retrieved 5/30/2023 from:

https://nida.nih.gov/publications/drugfacts/naloxone

Links to an external site.

National Institute on Drug Abuse (NIDA). (09/19/2022). Opioid Overdose. Retrieved 5/30/2023 from:

https://www.ncbi.nlm.nih.gov/books/NBK470415/#:~:text=In%20overdose%2C%20there%20is%20an,a%20decreased%20level%20of%20consciousness

Links to an external site..

Medanta. (2023). Necrotic Tissue. Retrieved 5/30/2023 from:

https://www.medanta.org/internal-medicine-hospital/disease/necrotic-tissue#:~:text=Necrotic%20tissue%20is%20the%20result,trauma%20in%20a%20particular%20organ

Links to an external site..

Fogoros, Richard. (09/02/2023). Causes and Risk Factors of Hyperkalemia. Retrieved 5/30/2023 from:

https://www.verywellhealth.com/hyperkalemia-causes-risk-factors-4135938#toc-cardiovascular

Links to an external site.

Teymouri, N., Mesbah, S., Navabian, S. M. H., Shekouh, D., Najafabadi, M. M., Norouzkhani, N.,

Poudineh, M., Qadirifard, M. S., Mehrtabar, S., & Deravi, N. (2022). ECG Frequency Changes in

Potassium Disorders: A Narrative Review. American Journal of Cardiovascular Disease,

12(3), 112–124.

National Institute on Drug Abuse (NIDA). (05/04/2022). Sex and Gender Differences in Substance Abuse.

Retrieved 5/30/2023 from: https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use

Genetics role in drug addiction.

According to (Genetics, 2022), Genetics is the scientific study of genes and heredity—how certain qualities or traits are passed from parents to offspring because of changes in DNA sequence. A gene is a DNA segment containing instructions for building one or more molecules that help the body work. For our society to understand the individual’s characteristics, genetics is researched to formulate treatments within their hereditary makeup. Genetics plays a huge part in drug addiction because it aids the healthcare provider in how to treat specific upyield adverse drug reactions. In this case study, Narcan is a drug that was used to displace opioids from the receptors of the CNS dropping double enone bond to a single bond.

Symptoms

Symptoms are the body’s reactions to letting the individual know there is an issue within one of the components of the body’s systems. A symptom (King, 1968) is a manifestation of a disease that appears to the patient himself, while a sign is a manifestation of the disease that the physician perceives. The sign is objective evidence of disease; a symptom is subjective. Symptoms represent the patient’s complaints; if severe, that complaint is measured. For example, in this scenario, the client woke up complaining of burning over his left leg, hip, and arm.

The assessment reveals that tissues in these areas are necrotic. According to (A.D.A.M Inc 1997-2023), Necrosis is the death of body tissue. It occurs when too little blood flows to the tissue. Necrosis can be from injury, radiation, or chemicals. Necrosis cannot be reversed. The client’s tissues in these areas were not receiving the correct blood supply or oxygenation for an unknown period. The proper amount of oxygenated blood supply is needed for tissues to function correctly in the body

Physiologic response

The client in this scenario displays a physiologic response derived from the brain and CNS system. The brain and the CNS system control a multitude of automatic bodily functionsOpioids can depress the brain and CNS causing the body to shut down in a state of unconsciousness. According to (Opioid Addiction: MedlinePlus Genetics, 2017), an overdose occurs when high doses of opioids cause breathing to slow or stop, leading to unconsciousness and death if the overdose is not treated immediately.

Opioids are known to cause many other physiologic responses. Researchers have shown (Dhaliwal, 2022) Opioid receptors are present in cardiac tissue; their activation leads to hyperpolarization of membranes and activation of the vagus nerve this can explain the clients EKG findings. These changes result in peripheral vasodilation and bradycardia, which ultimately causes hypotension. Peripheral vasodilation gets further exacerbated by systemic histamine release.

Cells Involved

There are several cells involved with opioid Tolerance. According to (Genetic Science Learning Center, 2013), Tolerance happens through changes at the cellular level, the G protein-coupled receptors (GPCRs) that control most of the body’s autonomic functions. These proteins activate the cAMP response, which in turn, PKA responds. According to (Dhaliwal, 2022), Recent advances in technology have elicited activation of G protein-dependent inward rectifying potassium channels (GIRK) on stimulation of GiCPR by agonists, including opioids, through the interaction of the G-beta-gamma subunit to the Kir channels.

New and upcoming reports have documented modulation of the MAPK/ERK pathway (Mitogen-activated protein kinase), which is involved in various cellular processes, including cell proliferation, differentiation, and apoptosis. It results from the brain restoring balance after repeatedly overstimulating by a drug. As the balance is restored, neurons, synapses, and entire brain regions work differently. The brain sets a new normal that includes the effects of the drug.

Based on genetics and gender.

According to (Bezrutczyk, 2023), women develop a dependence on opioids faster than men due to a heightened dopamine response in the brain. Men’s motility is higher due to their addiction to the drug. Researchers (Goodyear et al., 2022) showed that the White individual had higher stigma ratings compared to the Black individual (range of partial η2 = 0.002–0.004). An interaction effect demonstrated that a White female was rated higher responsible for opioid use than a Black female (Cohen’s d = 0.21). A Black male was rated with higher responsibility for opioid use than a Black female (Cohen’s d = 0.26). Last, we showed that a male and an individual who transitioned to heroin had higher stigma than a female and an individual who continued to use prescription opioids (range of partial η2 = 0.004–0.007).

References

A.D.A.M Inc. (1997-2023). Necrosis: MedlinePlus Medical Encyclopedia. Retrieved February

27,2023from https://medlineplus.gov/ency/article/002266.htm#:~:text=Necrosis%20is%20the%20death%20of,injury%2C%20radiation%2C%20or%20chemicals.

Bezrutczyk, D. (2023, February 9). The Differences in Addiction Between Men and Women – Addiction

Center. Addiction Center. Retrieved February 28, 2023, from https://www.addictioncenter.com/addiction/differences-men-women/#:~:text=Furthermore%2C%20women%20develop%20a%20dependence,as%20a%20result%20of%20abuse.

Dhaliwal, A. (2022, July 25). Physiology, Opioid Receptor. StatPearls – NCBI Bookshelf.

Retrieved February 28, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK546642/#:~:text=Opioid%20receptors%20are%20present%20in,bradycardia%2C%20which%20ultimately%20causes%20hypotension

Genetic Science Learning Center. (2013, August 30) Opioids and the Physiology of Tolerance. Retrieved

February 21, 2023, from https://learn.genetics.utah.edu/content/addiction/tolerance

Goodyear, K., Ahluwalia, J. S., & Chavanne, D. (2022). The impact of race, gender, and heroin use on

opioid addiction stigma. Journal of Substance Abuse Treatment, 143, 108872. https://doi.org/10.1016/j.jsat.2022.108872

King, L. S. (1968). Signs and Symptoms. JAMA, 206(5), 1063. https://doi.org/10.1001/jama.1968.03150050051011

Opioid addiction: MedlinePlus Genetics. (2017, November). Retrieved February 27, 2023,

from https://medlineplus.gov/genetics/condition/opioid-addiction/

U.S. Department of Health and Human Services. (2022, May 4). Genetics. National Institute of General Medical Sciences. Retrieved February 27, 2023, from https://nigms.nih.gov/education/fact-sheets/Pages/genetics.aspx#:~:text=Genetics%20is%20the%20scientific%20study,that%20help%20the%20body%20work.

Main Question Post

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.

NURS 6051 Discussion: Alterations in Cellular Processes

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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/

This paper is a case study involving a 27-year-old patient with a history of substance abuse who is

NURS 6051 Discussion Alterations in Cellular Processes
NURS 6051 Discussion Alterations in Cellular Processes

found unresponsive by emergency medical services. The patient becomes responsive after being administered naloxone. The essay examines the role of genetics, reasons for patient’s symptoms, physiological response, cells involved, and influence of other characteristics.

Genetics play a role in substance use disorders. For example, opioid use disorder has large risk of being inherited in families. Genes such as OPRM1 variates and A118G also predispose individuals to substance abuse disorder. Individuals of European descent with OPRD1 genes also have high predisposition to opioid use disorder. Additional genes include KCNG2, CNHIH3, KCNC1, RGMA, and APBB2 genes (Crist et al., 2019; Liu et al., 2019).

The patient presented with symptoms such as unresponsiveness due to central nervous system depression by the opiate overdose. The patient became response following the administration of naloxone since its an opiate antagonist that reverses the depressing effects of opiates. The patient reported pain in left hip and forearm because the effects of the opiates had ben reversed, hence, perception of pain. There is also tissue necrosis that may have developed due to poor tissue perfusion from depressed central nervous system, which affected circulation and respiratory system (Parthvi et al., 2019). The patient also developed respiratory acidosis, which increased serum potassium, hence, hyperkalemia and ECG changes.

The cells involved in the patient’s symptoms include mast cells, neutrophils, and macrophages. These cells induce the induction and transition of the pain the patient experience. Adaptive immune cells such as B and T cells also initiate and resolve pain. Characteristics such as age would change my response in this case study (Machelska & Celik, 2020). For example, the elderly patients have low sensitivity to pain stimuli and potentially worse outcomes due to opiate overdose. These changes will affect the treatment interventions.

In summary, substance abuse has genetic predisposition. The patient developed the given symptoms because of the effects of opioid overdose and naloxone. Age would affect the clinical symptoms and management of opiate overdose.

References

Crist, R. C., Reiner, B. C., & Berrettini, W. H. (2019). A review of opioid addiction genetics. Current Opinion in Psychology, 27, 31–35. https://doi.org/10.1016/j.copsyc.2018.07.014

Liu, M., Jiang, Y., Wedow, R., Li, Y., Brazel, D. M., Chen, F., Datta, G., Davila-Velderrain, J., McGuire, D., Tian, C., Zhan, X., Choquet, H., Docherty, A. R., Faul, J. D., Foerster, J. R., Fritsche, L. G., Gabrielsen, M. E., Gordon, S. D., Haessler, J., … Vrieze, S. (2019). Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. Nature Genetics, 51(2), Article 2. https://doi.org/10.1038/s41588-018-0307-5

Machelska, H., & Celik, M. Ö. (2020). Opioid Receptors in Immune and Glial Cells—Implications for Pain Control. Frontiers in Immunology, 11. https://www.frontiersin.org/articles/10.3389/fimmu.2020.00300

Parthvi, R., Agrawal, A., Khanijo, S., Tsegaye, A., & Talwar, A. (2019). Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit. American Journal of Therapeutics, 26(3), e380. https://doi.org/10.1097/MJT.0000000000000681

Sample Answer for NURS 6051 Discussion: Alterations in Cellular Processes Included

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.

Several changes happening inside the cell in reaction to environmental stressors cause changes in how the cell responds. The target cell picks up signals that signaling molecules send. The normal reaction of the target cell is to end the line. But disease changes the way cells respond, which leads to changes that aren’t normal in the way they normally respond. These modifications are frequently the result of disease and manifest as signs and symptoms. This essay looks at the case of a 16-year-old boy who goes to the clinic with a sore throat that won’t go away for three days and other symptoms. He does, however, have severe allergic responses after being given 500 mg of amoxicillin. As a result, this assignment looks at genetics, the way certain symptoms show up, and the effect of age.

Role of genetics.

People, especially kids, often have sore throats that come back. A Streptococcus group A bacterium is responsible for it, and genes are frequently involved. Sore throats that come back often are linked to genetic differences in the HLA area (Chauhan et al., 2016). Basically, these specific changes to the gene can be seen during genetic tests and have to do with how the immune system fights off pathogens. Because of this, the person is more likely to get a sore throat after the genetic changes that cause differences. It’s important to note that the immune system and genetic factors can make antibody reactions against Spe A bacteria do not work well enough (Chauhan et al., 2016). This makes it harder to recognize the Streptococcus group A bacteria factor.

Why does the patient present with these specific symptoms?

Changing the way cells normally respond in the body leads to the appearance of signs and symptoms of illness. For example, when Streptococcus group A bacteria get into the body, they make the throat swell and secrete pus. It also turns red. Because of this, symptoms are linked to Streptococcus pyogenes fibronectin-binding proteins living in the pharynx (Soderholm, Barnett, Sweet, & Walker, 2018). On the other hand, allergic reactions to the antibiotic were what caused the symptoms that patients experienced after taking the first 500 mg capsule of amoxicillin. Antibiotics can cause severe sickness and vomiting, dizziness, swollen lips and faces, fast heart rates, shortness of breath, wheezing, and even shock in some people.

Physiological response and cells involved in the process.

The patient’s body is reacting by showing a swollen back of the throat and white discharge from tonsils that are 3+ in size. It is also seen that there is positive anterior and posterior neck adenopathy. It was found that the patient had Streptococcus group A bacteria on the quick strep test. Physiological reactions are made up of adaptive and innate responses that work together to fight off the infection. Cellular mediators produce it along with chemokines, antimicrobial peptides (AMOs), eicosanoids, proinflammatory cytokines, and other substances that initiate and maintain host reactions. Epithelial cells, macrophages, neutrophils, and dendritic cells are some of these cells.

How age factors would change the response.

Age influences the risk of contracting diseases. In other words, some illnesses affect young people more than they affect old people. Children ages 5 to 15 are more likely to have sore throats than other age groups. Campbell et al. (2018) say that people have a 5–10% chance of getting a sore throat infection, even if they already have a strong immune system. So, the age of the person should be considered when safely prescribed medicine for a sore throat to avoid side effects and allergies.

References

Campbell, P. T., Frost, H., Smeesters, P. R., Kado, J., Good, M. F., Batzloff, M., … & Steer, A. (2018) Investigation of group A Streptococcus immune response in an endemic setting, with a particular focus on J8. Vaccine, 36(50), 7618-7624.

Chauhan, S., Kashyap, N., Kanga, A., Thakur, K., Sood, A., & Chandel, L. (2016). Genetic diversity among group A streptococcus isolated from the throats of healthy and symptomatic children. Journal of tropical pediatrics, 62(2), 152-157.

Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcus pharyngitis: Immune responses involved in bacterial clearance and GAS-associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.

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

Great Job Concepcion, I like the way you connect all the physiological responses to the diagnosis. I totally agree with you that the rhabdomyolysis is because of laying on the floor for an extended period, and  also that necrosis is directly related to physical trauma.

According to this patient situation, the patient was not responsive, and it was uncertain how long he had been lying there.  Evaluation in the Emergency room revealed large amounts of necrotic tissue over the greater trochanter as well as the forearm. This patient presented typical signs of Rhabdomyolysis. Rhabdomyolysis is a quick breakdown of muscle that causes the release of intracellular contents, which release protein pigment myoglobin into the extracellular space and bloodstream. This muscle damage can also contribute to hyperkalemia (McCance & Heuter, 2019).  Clinical management for this patient can include airway management, hydration, pain management and electrolyte imbalance management.

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

To go to the next week:

Week 1: Cellular Processes and the Genetic Environment

One of the more common biology analogies refers to cells as the “building blocks” of life. This rightfully places an emphasis on understanding cells, cellular behavior, and the impact of the environment in which they function.

Such an understanding helps explain how healthy cell activity contributes to good health. Just as importantly, it helps explain how breakdowns in cellular behavior and alterations to cells lead to health issues.

This week, you examine cellular processes that are subject to alterations that can lead to disease. You evaluate the genetic environments within which these processes exist as well as the impact these environments have on disease.

Learning Objectives

Students will:

  • Evaluate cellular processes and alterations within cellular processes
  • Evaluate the impact of the genetic environment on disease

Learning Resources

Required Readings (click to expand/reduce)

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

  • Chapter 1: Cellular Biology; Summary Review
  • Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
  • Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases
  • Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
  • Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
  • Chapter 7: Innate Immunity: Inflammation and Wound Healing
  • Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
  • Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
  • Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review
  • Chapter 11: Stress and Disease (stop at Stress, illness & coping)Summary Review
  • Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
  • Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review

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/

Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls

Required Media (click to expand/reduce)

Module 1 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 1 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Discussion and Assignment. (4m)

Foundational Concepts of Cellular Pathophysiology – Week 1 (14m)

Immunity and Inflammation

Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk  

Note: The approximate length of the media program is 14 minutes.

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds   

Note: The approximate length of the media program is 37 minutes.

Acid-Base Balance #1

MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE 

Note: The approximate length of the media program is 13 minutes.

Acid-Base Balance #2

MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI  

Note: The approximate length of the media program is 15 minutes.

Hyponatremia

MedCram. (2017, December 23). Hyponatremia explained clearly (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M 

Note: The approximate length of the media program is 15 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 3, 7, and 8 that relate to alterations in immunity, hyponatremia, and acid/base balance.

Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/store?role=student

To Register to View the Content

  1. Go to https://evolve.elsevier.com/cs/store?role=student
  2. Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
  3. Complete the registration process.

To View the Content for This Text

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  2. Click on Student Site.
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  5. Click on the plus sign icon for Resources on the left side of the screen.
  6. Click on the name of the textbook for this course.
  7. Expand the menu on the left to locate all the chapters.
  8. Navigate to the desired content (checklists, videos, animations, etc.).

Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.

it is true that cells are the basic structural components of the body and are specialized to conduct different functions in the body. The central dogma also illustrates the pivotal role of genes in dictating the specialization of cells and subsequent events. Disease can alter the nature of cells thereby interfering with the normal cell functions. I find your case analysis quite intriguing, there are many patients who complain of sore throat that is related to allergic conditions and your analysis through genetic involvement is informative (Centers for Disease Control and Prevention,2021).

Group A streptococcus pharyngitis among children and adolescents is common and the identification of the genes associated with the common occurrence provides an avenue for solving the menace. Hypersensitivity relation to genetic composition also provides a better understanding of the recurrence of such cases (McCance & Huether, 2019). I also think that the bod defense system is triggered by recognition of the pathogen and the process of acting against the identified antigen leads to the symptoms, which include inflammation that would be felt as sore throat.

I agree hat the physiological processes upon identification of the antigen includes a variety of cells mediators that take part in the inflammatory pathway. These processes cause heat, swelling and redness. The patient characteristics that define different responses include age as age relates to immunity. Children are more susceptible to some diseases as compared to adults. Elderly people are also prone to some diseases that are not so common among young adults. Allergy to drugs also links to age as the allergy increases with age (Soderholm et al., 2018). I concur with you that severe allergic reaction would definitely be a concern

References

Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal

pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.

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

adults and children (8th ed.). Mosby/Elsevier.

Centers for Disease Control and Prevention. (2021, November 23). Pharyngitis (strep throat): Information for clinicians. Retrieved March 1, 2022, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html

Kidney transplant is an effective treatment for patients suffering from end-stage renal disease. However, some patients develop adverse effects including kidney rejection. The management of kidney transplant rejection depends on the type and patient factors. Therefore, this paper examines why a patient with acute kidney transplant developed the described symptoms, genes associated with kidney transplant rejection and process of immunosuppression.

Why the Patient Presented the Symptoms Described

The patient presented symptoms that include gaining weight, decreased urinary output, fatigue, and running temperatures up to 101 F. The patient gained weight because of the increased body fluid volume level. The kidneys excrete excess fluids from the body. Impaired kidney function as seen in the case study affects the regulation of fluids in the body, hence, its accumulation and weight gain. The decline in renal function also impaired normal urine output. This led to reduced urine production, as seen in the case study.

The rejection altered the normal renal function in the excretion process, leading to oliguria. The kidneys also eliminate toxins from the body. This includes excess ammonia in urine. Impaired kidney problems affect the elimination of these toxins, which lead to symptoms such as fatigue, poor concentration, acidosis, and anemia. Therefore, this explains the patient’s experience of fatigue. Patients with end-stage renal disease and those with kidney transplant rejection problems also experience immunosuppression (Rauen et al., 2020). This predisposes them to infections, hence, the fever that the patient has.

Genes Associated with the Development of the Disease

Genes have been linked with kidney transplant rejection. They include cytochrome p450 2EI (CYP2EI), CYP3A5, cytotoxic T-lymphocyte associated protein 4 (CTLA4), C-X-C motif chemokine ligand 8 (CXL8), epoxy hydrolase 2, coagulation factor II thrombin, and coagulation factor V genes. In addition, Forkhead box P3, Fc fragment of IgG receptor IIA, major histocompatibility complex class II, I, DO alpha, and interleukin 1 beta, 2, 2-receptor subunit beta genes also play a role in the development of the rejection in kidney transplant.

Genes such as interleukin genes are inflammatory cytokines that inhibits inflammatory processes once a person received an allograft. On the other hand, this gene also downgrades the maturation of antigens and cells that develops host’s immunity following the transplant (Arnold et al., 2022; Spicer & Runkel, 2019; van Vugt et al., 2022). Other genes such as ATP-binding genes increase the body’s resistance towards drugs used in suppressing the immune system following the transplant.

Process of Immunosuppression

Immunosuppression refers to the state in which the ability of the body to fight infections is reduced. The immune system is lowered to a level that it cannot counteract any disease causing organisms from invading the body. The causes of immunosuppression include the use of medications that are used in conditions such as cancer. The other cause is conditions that depress the immune system such as cancer and HIV.

Treatments for cancer such as radiotherapy and chemotherapy also cause immunosuppression. The effects of immunosuppression are varied. They include increasing the vulnerability of patients to infections. It also increases costs that patients incur due to frequent hospitalizations (Gupta et al., 2021). Prolonged infections also affect the patients’ quality of life. Patients may also die in cases where the immune system is severely compromised.

Conclusion

In conclusion, the patient presented the symptoms because of reduced renal functioning. Genes are involved in the development of kidney transplant rejection. The rejection may result in immunosuppression, which has negative effects on health.

References

Arnold, M.-L., Heinemann, F. M., Oesterreich, S., Wilde, B., Gäckler, A., Goldblatt, D., Spriewald, B. M., Horn, P. A., Witzke, O., & Lindemann, M. (2022). Correlation of Fc Receptor Polymorphisms with Pneumococcal Antibodies in Vaccinated Kidney Transplant Recipients. Vaccines, 10(5), Article 5. https://doi.org/10.3390/vaccines10050725

Gupta, R., Woo, K., & Yi, J. A. (2021). Epidemiology of end-stage kidney disease. Seminars in Vascular Surgery, 34(1), 71–78. https://doi.org/10.1053/j.semvascsurg.2021.02.010

Rauen, T., Wied, S., Fitzner, C., Eitner, F., Sommerer, C., Zeier, M., Otte, B., Panzer, U., Budde, K., Benck, U., Mertens, P. R., Kuhlmann, U., Witzke, O., Gross, O., Vielhauer, V., Mann, J. F. E., Hilgers, R.-D., Floege, J., Floege, J., … Hilgers, R.-D. (2020). After ten years of follow-up, no difference between supportive care plus immunosuppression and supportive care alone in IgA nephropathy. Kidney International, 98(4), 1044–1052. https://doi.org/10.1016/j.kint.2020.04.046

Spicer, P., & Runkel, L. (2019). Costimulatory pathway targets for autoimmune and inflammatory conditions: Clinical successes, failures, and hope for the future. Expert Opinion on Investigational Drugs, 28(2), 99–106. https://doi.org/10.1080/13543784.2019.1557146

van Vugt, L. K., Schagen, M. R., de Weerd, A., Reinders, M. E., de Winter, B. C., & Hesselink, D. A. (2022). Investigational drugs for the treatment of kidney transplant rejection. Expert Opinion on Investigational Drugs, 31(10), 1087–1100. https://doi.org/10.1080/13543784.2022.2130751

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

The Group A Streptococcus colonize and multiple in the lymph nodes such as the tonsils which causes the cervical adenopathy seen in the patient. The body’s response to the bacteria is the release of B cells and antibodies that cause inflammation in the targeted regions (Strep throat, 2020). The treatment administered Amoxicillin can cause an allergic reaction in patients as indicated by the swelling and difficulty breathing in the 16-year-old patient.

Strep throat is a recurrent disease that can run in families and repeated treatments with Amoxicillin can cause the body to form antibodies to the antigen causing an allergic reaction response (Penicillin allergy, 2021). It is interesting that females are more susceptible to an allergic reaction to Penicillin however, males have a more severe reaction to the medication (Regateiro et al., 2020).

Reference

Penicillin allergy. (2021, September 21). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

Regateiro, F. S., Marques, M. L., & Gomes, E. R. (2020). Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors. International Archives of Allergy and Immunology, 181(7), 481–487. https://doi.org/10.1159/000507445

Strep throat. (2020). La Jolla Institute for Immunology. https://www.lji.org/diseases/strep-throat

Name: NURS_6501_Discussion_Rubric

  Excellent Good Fair Poor
Main Posting Points Range: 45 (45%) – 50 (50%)

Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Points Range: 40 (40%) – 44 (44%)

Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Points Range: 35 (35%) – 39 (39%)

Responds to some of the Discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.Points Range: 0 (0%) – 34 (34%)

Does not respond to the Discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.Main Post: TimelinessPoints Range: 10 (10%) – 10 (10%)

Posts main post by Day 3.Points Range: 0 (0%) – 0 (0%)

N/APoints Range: 0 (0%) – 0 (0%)

N/APoints Range: 0 (0%) – 0 (0%)

Does not post main post by Day 3.First ResponsePoints Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.Second ResponsePoints Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.ParticipationPoints Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on 3 different days.Points Range: 0 (0%) – 0 (0%)

N/APoints Range: 0 (0%) – 0 (0%)

N/APoints Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days.Total Points: 100

Name: NURS_6501_Discussion_Rubric

Case Study and Definition of the Disease 

A patient aged 83, with a history of malabsorption syndrome, is unable to eat because they lack dentures and presented to the emergency department with generalized edema of extremities and abdomen. The patient has protein malnutrition as her diagnosis. Malabsorption syndrome, as shown by the patient, is a disorder that hinders the absorption of nutrients in the small intestine. Malabsorption syndrome may result from factors such as infection, medicine, small intestinal surgery, and conditions including celiac disease (Montoro-Huguet et al., 2021). Indigestion and poor food absorption may lead to malnutrition, such as protein deficiency in the patient. 

The Role Genetics Play in the Disease

Elderly individuals have a decreased ability to adapt and regenerate, resulting in increased susceptibility to malnutrition and eventual illness (Norman et al., 2021). Malabsorption syndrome may be caused by variables such as nutrition, gastrointestinal disorders, and medicine. Genetic factors do not play a role in the patient’s malabsorption in this circumstance. The patient has a history of eating challenges stemming from the absence of dentures, resulting in protein deficiency. Su et al. (2020) assert that older individuals with dentures have an increased risk of malnutrition due to poor chewing and difficulty in breaking down food effectively, leading to impoverished nutritious intake. Considering the patient’s advanced age, eating habits, and absence of dentures, it is clear that dietary variables rather than inherited ones cause their condition.

Causes of the Symptoms

Based on the scenario, the patient presents generalized edema in the limbs and abdominal regions. Edema is the swelling of the tissue, accompanied by the deposition of excess fluid, which results in visible external swellings. The patient’s symptoms presumably are a result of hypoalbuminemia, an illness caused by low levels of the protein albumin in the serum, which is produced by the patient’s liver. Albumin is essential for regulating oncotic pressure, which helps retain fluids inside blood arteries (Soeters et al., 2019). The patient’s history of malabsorption syndrome has led to an inability to absorb protein, causing protein malnutrition and low albumin levels. Alterations in albumin levels may potentially allow the fluid in patients to seep into the patient’s surrounding intestinal areas, resulting in edema. 

Physiologic Response to the Stimulus Presented

The case study shows a physiological reaction characterized by the development of edema. Decreased albumin levels lead to reduced oncotic pressure, causing fluid to escape into intestinal gaps and resulting in edema, which is characterized by swelling in the limbs and belly. Old age is characterized by poor chewing and the inability to break down food properly as a result of poor dentures, which leads to inadequate nutrient intake in the elderly (Moynihan & Varghese, 2021). 

Cell Involved

Various cells are involved in malabsorption. Endothelial cells located in the microvilli of the small intestine create a monolayer that covers all blood vessels and controls the transfer of nutrients. Hepatocytes are important for lipid and protein metabolism (McCance & Huether, 2019). More protein results in a lack of amino acids for albumin synthesis in cells. Epithelial cells play a role in digesting food, absorbing nutrients, and maintaining intestinal balance. 

Another Characteristic that Would Change my response

Another factor that might influence my approach besides the patient’s elderly age is their race. If an African American had the listed symptoms, my reaction would include their genetic differences, cultural practices, socioeconomic issues, and healthcare inequities. Considering that there are certain dietary and health customs forbidden in their culture. For instance, certain traditional diets might lack key minerals, which may lead to malnutrition or malabsorption. As my religion, I eat a specific diet, and most of the time, it is hard for me to incorporate a high-protein diet into my daily schedule.

A Sample Answer for NURS 6051 Discussion: Alterations in Cellular Processes

Hello Colleagues,   

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. 

 

Thanks, 

 

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/ 

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