NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes

Walden University NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes-Step-By-Step Guide

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How to Research and Prepare for NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes                     

Whether one passes or fails an academic assignment such as the Walden University NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

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The introduction for the Walden University NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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After the introduction, move into the main part of the NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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A Sample Answer For the Assignment: NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes

Title: NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes

The role of genetics in malabsorption is a topic of ongoing inquiry within the medical community. While it is recognized that genetic factors can predispose individuals to certain digestive disorders, the extent to which genetics directly contribute to malabsorption remains to be fully elucidated. Genetic variations may influence the function of enzymes involved in digestion and absorption processes, affecting an individual’s ability to absorb nutrients effectively. However, the interplay between genetic predisposition and other factors such as diet, lifestyle, and gut microbiota further complicates the picture (Montoro-Huguet et al., 2021). Therefore, while genetics may play a role in malabsorption, it is likely to be multifactorial, with interactions between genetic susceptibility and environmental factors contributing to the overall pathology. Continued research efforts are needed to understand better the genetic underpinnings of malabsorption and its implications for diagnosis and treatment strategies.

Generalized edema in the extremities and abdomen can occur in patients with malabsorption due to several underlying mechanisms. One possible reason is protein malnutrition resulting from inadequate protein absorption in the gastrointestinal tract. Proteins play a crucial role in maintaining fluid balance within the body, and insufficient protein intake or absorption can decrease the concentration of plasma proteins, such as albumin and globulin (Busher, n.d.). This reduction in plasma protein levels can disrupt the oncotic pressure gradient between the blood vessels and the surrounding tissues, resulting in fluid accumulation and edema formation (Lumen Learning, 2020).

Additionally, malabsorption can lead to deficiencies in essential vitamins and minerals, such as vitamin B12, folate, and iron, which are necessary to function correctly in various physiological processes, including regulating fluid balance (Zuvarox & Belletieri, 2020). Deficiencies in these nutrients can impair the synthesis of red blood cells and lead to anemia, which may contribute to developing edema. Furthermore, malabsorption disorders, such as celiac disease or inflammatory bowel disease, can cause damage to the intestinal lining, leading to inflammation and increased intestinal mucosa permeability (Vanuytsel et al., 2021). This heightened permeability can allow fluid to leak into the interstitial spaces, contributing to edema formation.

The physiological response to the stimulus presented in the scenario, which likely involves malabsorption leading to generalized edema in the extremities and abdomen, is multifaceted and involves several interconnected mechanisms. Malabsorption can result in inadequate absorption of nutrients, including proteins, vitamins, and minerals, essential for maintaining fluid balance within the body. Proteins, in particular, play a crucial role in regulating oncotic pressure in the bloodstream. When protein levels decrease due to malabsorption, the oncotic pressure gradient between the blood vessels and surrounding tissues becomes disrupted. This imbalance leads to fluid leakage from the blood vessels into the interstitial spaces, contributing to edema formation.

The cells involved in malabsorption-induced generalized edema include those within the gastrointestinal tract and cells in the blood vessels and surrounding tissues. Within the gastrointestinal tract, various cells play essential roles in nutrient absorption. Enterocytes, which line the walls of the small intestine, are primarily responsible for absorbing nutrients, including proteins, vitamins, and minerals, into the bloodstream (Zuvarox & Belletieri, 2020). Damage to these cells, often seen in malabsorption disorders, can impair nutrient absorption and contribute to nutrient deficiencies. In the bloodstream, endothelial cells lining the blood vessels help regulate fluid balance by maintaining vascular integrity and permeability. Disruption of endothelial function, as observed in inflammatory states associated with malabsorption disorders, can lead to increased vascular permeability, allowing fluid to leak into the interstitial spaces.

The consideration of another characteristic, such as gender, genetics, or age, could significantly influence the response regarding malabsorption-induced generalized edema.

For instance, gender differences may impact the prevalence and presentation of certain malabsorption disorders. Some conditions, like celiac disease, have been shown to have a higher prevalence in females, which may affect the diagnostic approach and management strategies.

Genetic factors can also be crucial in predisposing individuals to malabsorption disorders (Marcuzzi et al., 2013). Specific genetic polymorphisms have been associated with an increased risk of conditions like Crohn’s disease or lactose intolerance, which can lead to malabsorption and subsequent edema. Age-related changes in gastrointestinal function and nutrient absorption may also affect the development and severity of malabsorption disorders. Elderly individuals may be more susceptible to certain conditions due to age-related alterations in gut physiology, medication use, or comorbidities. Therefore, considering additional characteristics such as gender, genetics, or age can provide valuable insights into the underlying mechanisms and clinical manifestations of malabsorption-induced edema, guiding tailored approaches to diagnosis and management for different patient populations.

One characteristic that could influence the response regarding malabsorption-induced generalized edema is the presence of comorbidities. Patients with pre-existing medical conditions, such as congestive heart failure, liver cirrhosis, or kidney disease, may experience edema due to mechanisms unrelated to malabsorption. In these cases, comorbidities may necessitate a broader differential diagnosis and tailored management approach to address the underlying pathophysiology contributing to edema. Additionally, the severity and progression of malabsorption disorders may vary depending on the presence of comorbidities, further influencing the clinical presentation and response to treatment. Therefore, considering the influence of comorbidities on the overall clinical picture is essential for accurate diagnosis and optimal management of malabsorption-induced edema.

The patient’s race, explicitly being African American, could influence characteristics related to malabsorption. Certain racial and ethnic groups may have differences in the prevalence, presentation, and outcomes of gastrointestinal disorders, including malabsorption disorders. Cultural dietary practices and preferences can influence the risk of malabsorption-related conditions. For instance, lactose intolerance, a common cause of malabsorption, is more prevalent among African Americans and other racial/ethnic groups with a high prevalence of lactase non-persistence (Malik & Panuganti, 2019). Cultural dietary patterns that include a high intake of dairy products may exacerbate symptoms of malabsorption in individuals with lactose intolerance.

NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes

NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes

The client was unresponsive due to high opioid dosage/overdose. After Narcan administration in the field, the patient regained consciousness as the drug is an opioid antagonist. This drug reversed the opioid’s actions that led to the patient’s unconsciousness (Britch & Walsh, 2022). Opioids depress the respiratory system causing respiratory distress failure. This scenario explains why the patient passed following respiratory distress or failure (Britch & Walsh, 2022).

After the patient passed, he likely experienced necrosis, which is due to falling. The client might have also suffered from a broken bone or cellular damage. Necrosis might also be a result of lying in the same position for an extended period. This situation might explain why the client is experiencing pain in the left forearm and hip (Stahl et al., 2019). Besides, Rhabdomyolysis can cause Necrosis. The condition can also be caused by the death of tissues and cells which might be caused by the lack of oxygen supply (Stahl et al., 2019). As the muscle tissue and cells get damaged, they release electrolytes and proteins into the blood system which could explain the patient high level of Potassium in the patient’s blood system (Stahl et al., 2019). The high levels of Potassium in the body could be the reason for the prolonged PR interval and peaked T-waves (Stahl et al., 2019).

Genetics and environmental factors are crucial for influencing an individual addiction behavior. Individuals with close relatives with addictive behaviors are highly likely to become addicts. However, environmental factors can also influence a person’s addiction vulnerability. Moreover, gender does not play a role in influencing patient addiction. Fattore et al. (2020) study shows that clinical representation overdose between men and women was indifferent. Nonetheless, age was a critical factor due to decreased metabolism and excretion in old age (Fattore et al., 2020). Another study also points out that individuals with COPD and heart conditions were likely to overdose on opioids (Bedene et al., 2019).

References

Bedene, A., Lijfering, W. M., Niesters, M., van Velzen, M., Rosendaal, F. R., Bouvy, M. L., Dahan, A., & van Dorp, E. L. A. (2019). Opioid Prescription Patterns and Risk Factors Associated with Opioid Use in the Netherlands. JAMA Network Open, 2(8), e1910223–e1910223. https://doi.org/10.1001/jamanetworkopen.2019.10223

Britch, S. C., & Walsh, S. L. (2022). Treatment of opioid overdose: current approaches and recent advances. Psychopharmacology, 239(7), 2063–2081. https://doi.org/10.1007/s00213-022-06125-5

Fattore, L., Marti, M., Mostallino, R., & Castelli, M. P. (2020). Sex and Gender Differences in the Effects of Novel Psychoactive Substances. Brain Sciences, 10(9), 606. https://doi.org/10.3390/brainsci10090606

Stahl, K., Rastelli, E., & Schoser, B. (2019). A systematic review on the definition of rhabdomyolysis. Journal of Neurology. https://doi.org/10.1007/s00415-019-09185-4

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

This paper is being written to explain the pathology of cystic fibrosis. I personally have a friend who

has this disease and have learned from her. The topics that will be covered are, how cystic fibrosis is created at a cellular level, genetics role in cystic fibrosis, the reasoning for the symptoms that the patient presented with, the description of the cells involved in cystic fibrosis, and how other characteristics would change the child’s response to cystic fibrosis. In short what I remember from nursing school is that cystic fibrosis is a genetic disorder which is an autosomal recessive gene that is carried by both the mother and the father. The abnormality occurs in chromosome 7 which is where creates an inability to transport small molecules across the cell’s membrane, which in turn, dehydrates the cells of the epithelium and this then creates dry secretion. This is a broad overview of what this disease is, but I will go into further detail below.

 The Role Genetics Plays in the Disease

Genetics play an important role in this disease, according to an article published in PubMed titled Cystic fibrosis genetics: from molecular understanding to clinical application states that due to a defective epithelial cell that is defective, this cell is inherited and is an autosomal recessive gene. The genetic information that is in the cell, which is the recipe for the cell to make proteins (Cutting, 2015).

According to Pathophysiology of disease: An introduction to clinical medicine, if a person receives a cystic fibrosis transmembrane conductance regulator gene (CFTCR), or a person can receive two copies of the CFTCR gene. This copy has a mutation of the cystic fibrosis gene, furthermore these two copies of the CFTR gene have stored a mutation which is the on chromosome seven. So, when the recipe is being presented to the cell to be made, the genetic information is then stored into the deoxyribonucleic acid which is known as DNA.  This is part of the twenty-three pairs of chromosomes, but on the seventh chromosome, the cystic fibrosis recipe is stored in that chromosome. In the DNA, where the CFTCR gene recipe lives, if there is one copy of the recipe than the gene will not show up in the person but will be a carrier but if there are two copies of the recipe being stored in the chromosome than the cystic fibrosis gene than the person will have cystic fibrosis (McCance at el., 2019).

 Why the Patient is Presenting with the Specific Symptoms Described

The baby’s symptoms included salty skin, a swollen stomach on occasion, and a failure to gain weight normally. According to an article published in the Journal of Cystic Fibrosis titled Inflammation in cystic fibrosis lung disease: Pathogenesis and therapy, epithelia make up the major organ systems. The sweat glands, liver’s bile duct, and intestines in the gastrointestinal tract are all affected in this patient. The article goes on to explain that the patient suffers from malnutrition and does not grow normally as a result of the loss of pancreatic function. As a result, enzyme replacement is critical for this patient in order to prevent cell clogging caused by an inability to breakdown a key nutrient (Cutting, 2015).

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

After reading different sources, I was able to breakdown the pathology behind this patient’s symptoms. This disease starts with the CFTR gene protein being mutated in the chromosome seven, which there are two copies of the recipe, this mutation causes the decrease of chloride acceptance and ion being transported, then this makes the absorption of water to increase which throws off ciliary from completing the job and there is mucus that is dry, this is what causes the skin to be salty of the baby.

The stomach inflammation and swelling that is being experienced, is due to the CFTR gene protein not having the right recipe present to the epithelial cell, this is causing malfunction by changing the reabsorption of the sodium, chloride and potassium in the cell, the recipe tells the cell to keep the sodium, chloride and potassium outside of the cell, this causes a back-up of outside of the cell structure and blocks the cell from absorbing the nutrients especially, proteins, fats and vitamins that are fat soluble.

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The Cells that are Involved in this Process

The cells involved in this process begin with epithelial membranes found in the digestive tract, pancreas, airways, and reproductive area. According to an article in Apoptosis Journal, cystic fibrosis is caused by epithelial cell dysfunction, which leads to inflammation and an inability to create homeostasis due to the CFTR gene’s constant inflammation. Furthermore, the epithelial cells fail and undergo apoptosis as a result of the inflammation that occurs in the endoplasmic reticulum (Soleti at el., 2013).

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

For cystic fibrosis, it is important to understand that this would not be a disease if the parents did not carry the gene. The

gene is the CFTR gene mutation, mentioned throughout this paper. According to a study done by Harvard Stem Cell Institute, where a lung cell was isolated to examine the function of the CFTR gene. It was shown in the study that if the ionocytes in the cell are not doing their job because it is expressing CFTR gene in increased levels, then the symptoms are created in the cell (Montoro at el., 2018). This occurs in the form of thick mucus and creates the response in the body that does not allow for the patient to regulate sodium, chloride, and potassium in a normal fashion.

Conclusion

During this journey of studying disease in depth and truly understanding how they work will help in the future of my career. I believe that if screening done at the hospitals before they leave would be beneficial. When parents are informed about the possibility of something occurring and what it means, parents will be empowered and get treatment before or if cystic fibrosis symptoms could show up. Also, encouraging parents to come to their baby checkups, will also allow for the medical staff to ask the right questions and treat the baby early, if they see symptoms. Cystic fibrosis is a challenge some patients may struggle with and it is our job as practitioners to catch things before extreme measures need to be taken.

Occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Sample Answer for NURS 6501 Advanced Pathophysiology Week 1 Discussion Alterations in Cellular Processes Included

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.

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Read a selection of your colleagues’ responses.

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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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

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

Naloxone is an FDA-approved medication intended to counteract the effects of opiate misuse and overdose. The medication is an opioid antagonist that competes with opiates for opioid receptors, resulting in a significant reduction in the effects of opioids (Dunne, 2018). With larger dosages, opioids are known to produce bradycardia and breathing suppression, which can lead to fainting. Moreover, naloxone is only effective against opioids. Consequently, the patient’s fast response after the medicine was provided shows that his immediate state was caused by opiate misuse or overdose.

However, Rhabdomyolysis is my diagnosis of the patient’s sickness after examining all of the presenting signs and symptoms. The illness is a fatal medical ailment that involves the deterioration of muscle tissue and the entry of such tissues into the blood circulatory system. The tissue causes broad harm to the body, most notably renal failure (Kruijt et al., 2021). The appearance of necrotic tissue on the patient’s hip and forearm, as well as discomfort in those areas, suggest substantial muscle tissue deterioration. This could be a result of cellular damage from a fall or injury, or abuse of injectable narcotics (Waldman et al., 2020).

At the cellular level, a shortage of ATP or muscular damage causes an influx of intracellular sodium and calcium. Sodium causes swelling and rupture of the membranous structure by drawing water into the cell. Excess intercellular calcium promotes actin-myosin cross-linking, myofibrillar contraction, and ATP consumption. Reperfusion induces leukocyte migration into injured muscles, resulting in a rise in cytokines, prostaglandins, and free radicals (Stanley et al., 2022). This causes increased muscle fibre necrosis and the release of muscle breakdown byproducts such as potassium, creatine kinases, phosphate, uric acid, and myoglobin into the bloodstream.

Genetic factors play a role in the development of the condition. Hereditary diseases such as mitochondrial disorders, metabolic muscle disorders, muscular dystrophies, excitation-contraction coupling abnormalities, and intramuscular calcium release disorders make one more susceptible to Rhabdomyolysis (Scalco et al.,2015). Establishing a genetic relationship to rhabdomyolysis is challenging due to the various possible genetic conditions that can predispose one to the medical condition. However, it may be crucial clinically to prevent future crises.

This patient’s ECG revealed a prolonged PR interval and peaked T waves. Peaking T waves are early indicators of hyperkalemia  (Hunter & Bailey, 2019). The potassium level was 6.9 mEq/L, indicating mild hyperkalemia. Therefore, the patient is suffering from a secondary case of hyperkalemia due to the release of potassium from cellular breakdown into the bloodstream.

References

Dunne, R. B. (2018). Prescribing naloxone for opioid overdose intervention. Pain Management, 8(3), 197-208. https://doi.org/10.2217/pmt-2017-0065

Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: pathophysiology, risk factors and consequences. Nephrology Dialysis Transplantation, 34(3), iii2-iii11. https://doi.org/10.1093/ndt/gfz206

Kruijt, N., van den Bersselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoeck, M. M. J., Everaerd, D. S., … & Voermans, N. C. (2021). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. European Journal of Neurology, 28(2), 647-659. https://doi.org/10.1111/ene.14553Links to an external site.

Scalco, R. S., Gardiner, A. R., Pitceathly, R. D., Zanoteli, E., Becker, J., Holton, J. L., Houlden, H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a genetic perspective. Orphanet journal of rare diseases, 10(1), 51. https://doi.org/10.1186/s13023-015-0264-3

Stanley, M., Chippa, V., Aeddular, N., Quintanilla Rodriguez, B., & Adigun, R. (2022). Rhabdomyolysis – statpearls – NCBI bookshelf. National Library of Medicine. Retrieved March 4, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK448168/

Waldman, W., Sein Anand, J., & Kabata, P. (2020). The characteristics and outcomes of toxin-induced massive rhabdomyolysis. International Journal of Occupational Medicine and Environmental Health, 33(5). https://doi.org/10.13075/ijomeh.1896.01532Links to an external site.

My scenario is: 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. 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.

• The role genetics plays in the disease.
  • The patient could have had a genetic predisposition to substance abuse which contributed to his current situation of an overdose and associated rhabdomyolysis
• Why the patient is presenting with the specific symptoms described.
  • The patient is likely presenting with opiate overdose due to history of substance abuse and response to naloxone. Additionally the patient is likely suffering from infection of drug administration sites and AKI rhabdomyolysis from laying on the floor for an extended period of time.
• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
  • The unconscious state is directly related to the opiate overdose. The necrosis is directly related in response to physical trauma and infection from drug use as well as mechanical trauma from having fallen and remaining in a fixed position. The hyperkalemia is as a result of the AKI caused by rhabdomyolysis from the patient having been down for an extended period of time.
• The cells that are involved in this process.
  • Epithelial cells that are damaged as result of the trauma, cells within the kidney responsible for protein clearing as well as potassium excretion,
• How another characteristic (e.g., gender, genetics) would change your response.
  • A much older patient would have changed my rationales as they would be at a higher risk for accidental overdose and would be at an increased risk for falls and AKI with multiple comorbidities.

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 functions. Opioids 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.

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