Alterations in Cellular Processes
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Discussion: Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in the 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.
Respond to the case study/discussion below, whether you respectfully agree or disagree with the case assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
Case Study:
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:
Genes influence the numbers and types of receptors in peoples’ brains, how quickly their bodies metabolize drugs, and how well they respond to different medications (U.S. Department of Health and Human Services, 2022). Scientists will never find just a single genetic change that causes addiction. Substance use disorder is a very complex trait. It’s influenced by variations in multiple genes, plus factors from the environment. Every person inherits a unique combination of gene variations. (Genetic Science Learning Center, n.d.). People with substance use disorder can have different underlying genetic causes and they may share certain high-risk variations. However, they may or may not have the trait. Segments of chromosomes are inspected and DNA is compared within family members to identify genes that are engaged in addiction. While finding the precise genetic cause is tricky, multiple lines of research do show that genes influence substance use. From careful studies, scientists estimate a person’s genetics account for 40-60 percent of their risk (Genetic Science Learning Center, n.d.).
Why the patient is presenting with the specific symptoms described:
The patient is presenting with the specific symptoms described because he has experienced an opiod overdose. Dopamine is a neurotransmitter that is released when a person experiences pleasure. When a person ingests a drug, their brain produces large amounts of dopamine. Over time, the continued release of dopamine causes changes within the brain that affect memory. The person will experience withdrawal symptoms and this will aid in their continued drug use even though it is dangerous. This is an affirmed drug overdose because the patient became responsive after receving a dose of Naloxone. Naloxone is an opioid antagonist which reverses an opioid overdose and has a higher affinity for opioid receptors than most opioids. Naloxone occupies and blocks the receptors for 30-90 minutes. The large amount of necrotic tissue over his greater trochanter and left forearm can be attributed to the patients fall and the amount of time he was laying unresponsive. Due to the patient laying on his left hip and left forarm blood flow was restriction from flowing to these specific areas of his body. Necrotic tissue occurs when the tissue cells die due to lack of oxygen. This patient has most likely developed rhabdomylosis, which is breakdown of the muscle tissue caused by an injury and can be caused by long term drug abuse.
Physiologic response to the stimulus presented in the scenario and why this response occurred, including the cells involved in this process:
Hyperkalemia has occured because of the direct release of intracellular potassium into the extracellular fluid. Hyperkalemia was also the cause for the prolonged PR interval and peaked T waves. The muscle damage can be from direct injury/trauma or by metabolic inequalities resulting in direct sarcolemmic injury or ATP depletion within the muscle fiber (National Library of Medicine, 2022). Depletion of ATP impairs intracellular calcium regulation (usually, muscle cells maintain low levels of calcium at rest and increased calcium necessary for actin–myosin-binding during contraction), resulting in a persistent increase in sarcoplasmic calcium, causing persistent contraction, energy depletion, and activation of calcium-dependent proteases, phospholipases and eventual destruction of myofibrillar, cytoskeletal, and membrane proteins, followed by lysosomal digestion of fiber contents (National Library of Medicine, 2022).
How another characteristic (e.g., gender, genetics) would change your response:
My response regarding this case study wouldn’t change becasue this particular patient is a male. Men are more likely than women to use almost all types of illicit drugs,13 and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women (National Institutes of Health, 2021). Regardoing genetics, as previsely mentioned, people with substance use disorder can have different underlying genetic causes and they may share certain high-risk variations.
References
Cleveland Clinic. (2019, 4). Rhabdomyolysis: Symptoms, treatments. Retrieved from https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis
Genetic Science Learning Center. (n.d.). Genes Affect Your Risk for Addiction. Genes and Addiction. Retrieved August 29, 2022, from
https://learn.genetics.utah.edu/content/addiction/genes
National Institutes of Health. (2021, April 13). Sex and gender differences in substance use. Retrieved from https://nida.nih.gov/publications/research-reports/substance-use-
in-women/sex-gender-differences-in-substance-use
National Library of Medicine. (2022, April 1). Rhabdomyolysis – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448168/
U.S. Department of Health and Human Services. (2022, April 26). Genetics and epigenetics of Addiction Drugfacts. National Institutes of Health. Retrieved August 29, 2022,
from https://nida.nih.gov/publications/drugfacts/genetics-epigenetic addiction#:~:text=Genes%20influence%20the%20numbers%20and,advance%20the%20science%20of%20addiction.
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