NURS 6501 Discussion Alterations in Cellular Processes

A 16-year-old boy was diagnosed with streptococcal pharyngitis at the clinic after a positive strep test. Red patches on the roof of the mouth, inflamed tonsils, white dots on the tonsils and rear of the mouth are all indications of strep throat (Askarian et al, 2019). Tonsilitis (tonsil inflammation) may be because of viral or bacterial or infection. The bacteria that is associated with strep throat infection is Streptococcus pyogenes. The most common way for strep pharyngitis to transmit is from person to person via saliva or nasal discharge.

The role genetics plays in sore throat.

For children with repeated strep throat infections a research found there is a genetic predisposition that causes a poor response to group A strep bacterium immunity (Dan et al, 2019). The children with recurrent tonsillitis were found to have fewer immune cells called B cells in their tonsils. Recurrent tonsillitis may result in tonsillectomy due to overuse of antibiotics to treat it.

Reasons for the patient presenting with the specific symptom.

The patient had swollen tonsils with white exudate, a fever of 99.6, a sore throat, and a reddish pharynx, all of which were symptoms of streptococcal pharyngitis. The positive result of strep test was confirmation of streptococcal pharyngitis for the patient.

Inflammation and soreness in the throat are symptoms of strep throat. Some symptoms of the sore throat may be mild but if left untreated, it could result in serious problems like acute rheumatic fever, that raises the risk of heart problems (Beaudoin et al, 2015). Antibiotics are a simple solution for strep throat.

The physiologic response to the stimulus

The patient had been prescribed amoxicillin. After the patient took the medication, there was a physiologic response that manifested as an allergic reaction. The patient experienced swollen lips and tongue, as well as trouble breathing with noticeable wheezing.

The cells that are involved in this process.

After the patient took the amoxicillin (the allergen), the body instantaneously reacted; the immune system produced Immunoglobulin E (IgE)-antibody that circulates in the bloodstream to remove the allergen (McCance, 2019). The inflammatory response is triggered by mast cells and basophils. Many receptors specific to the IgE antibody are found in both basophils and mast cells.

Characteristic that may affect sore throat.

Some characteristics may influence the incidence and recovery after sore throat infection. Children are more affected by sore throat than adults. This could be due to the children being in close proximity at daycare or school. According to CDC, the most prevalent bacterial cause of pharyngitis in children is group A strep, which accounts for 20% to 30% of all cases, while in adults, it is thought to cause 5% to 15% of pharyngitis infections (2018). Due to older adults having weak immune response, they may take a longer time to recover after infection than young adults.

Also Read: Assignment: Change Implementation and Management Plans

References

Askarian, B., Yoo, S.-C., & Chong, J. W. (2019). Novel Image Processing Method for Detecting Strep Throat (Streptococcal Pharyngitis) Using Smartphone. Sensors (Basel, Switzerland), 19(15). https://doi-org.ezp.waldenulibrary.org/10.3390/s19153307

 Beaudoin, A., Edison, L., Introcaso, C. E., Goh, L., Marrone, J., Mejia, A., & Van Beneden, C. (2015). Acute rheumatic fever and rheumatic heart disease among children–American Samoa, 2011-2012. MMWR. Morbidity and Mortality Weekly Report, 64(20), 555–558.

 CDC. (2018).  Pharyngitis (Strep Throat). Retrieved, June 1, 2021. From

https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html 

Dan, J. M., Havenar-Daughton, C., Kendric, K., Al-Kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, P., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam Arlehamn, C. S., Sette, A., Nizet, V., Bothwell, M., Brigger, M., & Crotty, S. (2019). Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant T_FH cells. Science translational medicine, 11(478), eaau3776. https://doi.org/10.1126/scitranslmed.aau3776

McCance, S.H. K (2019). Pathophysiology. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9780323583473/

NURS 6501 Discussion Alterations in Cellular Processes

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

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: NURS 6501 Discussion Alterations in Cellular Processes

• The role genetics plays in the disease.
• Why the patient is presenting with the specific symptoms described.
• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
• The cells that are involved in this process.
• How another characteristic (e.g., gender, genetics) would change your response.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Week 1 Case Study: NURS 6501 Discussion Alterations in Cellular Processes

The case study assigned is that of a 27 year old male with a history of substance abuse who was found unresponsive by EMS. Patient was unresponsive for an unknown amount of time. Patient became responsive after he was given naloxone by the EMS personnel. Patient noted to have necrotic tissue over greater trochanter and his left forearm after he complained of burning sensation. The patient has prolonged PR interval and peaked T wave. He was also found to have a potassium level of 6.9 mEq/L.

The Role Genetics Pay in Opioid Drug Use

A review of classical genetic studies of opioid use suggests heritability of drug use behavior. However the evidence from molecular genetic studies is inconclusive. Nonetheless, certain genetic variants are important to consider given their role in the pathophysiology of addictive behavior.(Chetna et al,2014). Polymorphisms disrupting the opioid and dopamine systems have been associated with increased risk for developing substance use disorders. Molecular imaging studies have revealed how these polymorphisms impact the brain and contribute to cognitive and behavioral differences across individuals. (Burns et al, 2019). NURS 6501 Discussion Alterations in Cellular Processes

Why is the Patient Presenting with the Specific Symptoms?

The patient in this scenario is experiencing burning sensation because of necrosis in the hip and the forearm. This necrosis may be as a result of opioid IV drug abuse since this practice can lead to the development of necrosis in soft tissues. Necrosis is a form of cell injury which results in cell death resulting from internal or external factors such as mechanistic injuries or chemical agents. Necrotic cells cease to function and if necrosis is sufficiently extensive, clinical disease results. If a patient has hyperkalemia, giving naloxone can precipitate arrhythmias and this might have been the case for this patient.. As the patient was given naloxone, the effects of the opioid drugs rapidly wore off causing the patient to go from high pain tolerance to low pain tolerance and thus the reason for the complaints of pain in the hips and forearm. Naloxone is an opioid antagonist that reverses coma and respiratory depression caused by opioids.

How would gender change the response?

There is a growing evidence to suggest that men and women are impacted differently by opioid use disorder. The difference between men, women, and gender diverse people are boundless. A study found that women are susceptible to a heightened burden of disease from opioid use disorder. (Reekum et al, 2020). Women are more likely to suffer substance abuse side effects such as liver damage and opioid overdose. Because of this fact, we can conclude that although different genders are impacted differently by opioid use, it would have made no difference in this scenario. NURS 6501 Discussion Alterations in Cellular Processes

References

Chetna J. Mistry., Monica, B., Dipika, D., David C.M., & Saaman, Z. (2014). Genetics of Opioid     Dependence: A Review of the Genetic Contribution to Opioid Dependence. Current Psychiatry Reviews. Retrieved September 03, 2020 from             https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155832/

Jamie A. Burns, Danielle S. Kroll, Dana E. Feldman, Christopher Kure Liu, Peter Manza,       Corinde E. Wiers, Nora D. Volkow, & Gene-Jack Wang. (2019). Molecular Imaging of             Opioid and Dopamine Systems: Insights Into the Pharmacogenetics of Opioid Use             Disorders. Frontiers in Psychiatry, 10. https://doi-             org.ezp.waldenulibrary.org/10.3389/fpsyt.2019.00626

Van Reekum, E. A., Rosic, T., Hudson, J., Sanger, N., Marsh, D. C., Worster, A., Thabane, L., &   Samaan, Z. (2020). Social functioning outcomes in men and women receivi medication-assisted treatment for opioid use disorder. Biology of Sex Differences, 11(1),         1–11. https://doi-org.ezp.waldenulibrary.org/10.1186/s13293-020-00298-4. NURS 6501 Discussion Alterations in Cellular Processes

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

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.

Next Week

To go to the next week:

Week 2

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)

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

1. Go to https://evolve.elsevier.com/
2. Click on Student Site.
3. Type in your username and password.
4. Click on the Login button.
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.

RE: Discussion – Week 1

Top of Form

 The scenario for this week deals with Malabsorption Syndrome with Protein Malnutrition. The usefulness of the food we eat to the body depends on many factors, including the level of activities, age, the type of food, and the time of eating. Malabsorption can result from the impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins. Malabsorption syndrome is characterized by chronic diarrhea, abdominal distention, and failure to thrive or grow (Crichton et al., 2019). In this case, the patient has a history of malabsorption syndrome and presented with severe protein malnutrition. Elderly without teeth or dentures can develop malabsorption due to their inability to mechanically break down food which is critical for absorption of nutrients from meat (Keller & Layer, 2014). Also, older adults without dentures have weight loss due to reduced nutrient intake, thus increasing mortality (Keller & Layer, 2014)

Role of Genetics in Malabsorption Syndrome

Genetic can be a significant factor in nutritional processes such as absorption, metabolism, receptor action, and excretion (Paoloni-Giacobino, Grimble, & Pichard, 2019). However, in the case study, it will not be suitable to conclude that genetics places a significant role in the cause of the symptoms or disease process presented by the patient. The patient described in the case study is at a period of life where a general reduction in function occurs throughout the body at the cellular and organ level; the extent of changes depends on the individuals’ genetic makeup, lifestyle, and health choices (McCance & Huether, 2019) As a body age, its cells are characterized by a decrease in function, apoptosis, and atrophy. All these will result in changed cellular processes compared to the cells in a young person’s body. There is less protein synthesis and more degradation, less metabolism due to decreased movement and muscle strength, among other activities.  Aging can also lead to a reduction or loss of smell, taste, and dryness of mucosa membrane and glands of the digestive tract, which makes eating not so desirable to the elderly, thus affecting their digestive secretions and absorption of essential nutrients and vitamins, resulting in anemia and loss of electrolytes (McCance & Huether, 2019).

Explanation of Patient’s Symptoms

The patient presented generalized edema, which includes peripheral edema and abdominal edema; this formation of edema shows that there is malabsorption and protein malnutrition which are major tracts seen in patients with Kwashiorkor; these happen due to fluid imbalances in the cells and blood vessels. (Benjamin & Lappin, 2020) Also, salt intake as a result of the reduction or lost sense of taste in the elderly can result in more consumption of salt, causing excessive sodium levels in the extracellular fluid resulting in edema from retained sodium, promoting fluid accumulation in the interstitial compartment causing reduced fluids to flow to the blood (McCance & Huether, 2019). This patient may also have skin breakdown due to accumulation of fluids which can delay wound healing, and inadequate nutrition intake because he does not have teeth and does not use dentures. Adequate protein is needed to ensure wound healing which the patient will lack from poor absorption of most needed nutrients for this age group, like protein and calcium (Bachar et al., 2021). The lack of dentures will cause the patient to behave difficulty eating meats high in protein, good for wound healing.

Lastly, it will be good to note that apart from aging, other factors can affect protein malnutrition, such as gender (Simopulos, 2019). Other factors such as decreased appetite, disease process or diagnosis, social-economic settings, medication regimens could also affect the patient.

References: 

Benjamin, O. & Lappin, S.L. (2020) Kwashiorkor. StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK507876/.

Bachar, W. E., Manchanda, M., Bansal, R., Karlsson, M., Kelly, P. P., Sköldenberg, O., & Wikstrom, J. D. (2021). Endoplasmic reticulum stress in human chronic wound healing: Rescue by 4‐phenylbutyrate. International Wound Journal, 18(1), 49–61. https://doiorg.ezp.waldenulibrary.org/10.1111/iwj.13525

Crichton, M., Craven, D., Mackay, H., Marx, W., de van der Schueren, M., & Marshall, S. (2019). A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex. Age and Ageing, 48(1), 38–48. https://doi-org.ezp.waldenulibrary.org/10.1093/ageing/afy144

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

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

Paoloni-Giacobino, A., Grimble, R., & Pichard, C. (2003). Genetics and nutrition. Clinical nutrition (Edinburgh, Scotland), 22(5), 429–435. https://doi.org/10.1016/s0261- 5614(03)00064-5

Simopoulos, A. P. (2019). Genetic variation and evolutionary aspects of diet. In Antioxidant status diet, nutrition, and health (pp. 64-89). CRC Press.

NURS_6053_Module03_Week06_Assignment_Rubric