Alterations in Cellular Processes

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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.

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

 

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

Excellent Good Fair Poor
Main Posting 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. 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. 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. 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: Timeliness 10 (10%) – 10 (10%)
Posts main post by Day 3. 0 (0%) – 0 (0%)
N/A 0 (0%) – 0 (0%)
N/A 0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response 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. 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. 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. 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 Response 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. 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. 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. 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.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on 3 different days. 0 (0%) – 0 (0%)
N/A 0 (0%) – 0 (0%)
N/A 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.

Group B

Scenario 4: 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.

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Solution

Alterations in Cellular Processes

Genetics’ Role in the Disease

Genetics play a role in substance abuse disorders. Alongside environmental factors, they are attributed to dependence behavior in substance abuse and relapse. Wang et al. (2019) explain that family members of persons with a history of an opioid use disorder are 10-fold times more likely to have opioid-related substance use disorders. The risk is higher if the person has a history of cannabis or cocaine abuse (Wang et al., 2019). Therefore, the patient’s substance abuse disorder can be associated with genetics if he had a first-degree relative with a substance use disorder.

Causes of the Patient’s Symptoms

The patient’s unresponsive state can be attributed to opiate overdose, which causes respiratory depression, depression of the central nervous system, and miosis (Wang et al., 2019). Necrotizing fasciitis is a complication of opioid overdose, which can cause burning pain over the left hip and forearm. Rhabdomyolysis is also an opiate overdose complication and can be attributed to the necrotic tissue on the greater trochanter.

The Physiologic Response to the Stimulus

The patient was administered naloxone, an opioid antagonist that reverses the effects of an opioid overdose. The patient became responsive since naloxone rapidly restores the normal breathing from an opioid overdose (Rzasa Lynn & Galinkin, 2018). Naloxone prolongs the Q-T interval due to a delay in repolarization, which causes the prolonged PR interval and peaked T waves.

Cells That Are Involved In This Process

Cells that mediate opioid effects include mu, kappa, and delta. Opioids are potent agonists to mu receptors that cause a complex gush of intracellular signals that trigger dopamine release, block pain signals, and cause euphoria (Rzasa Lynn & Galinkin, 2018).

How another Characteristic Would Change My Response

Gender would change my response since males are at a high risk of opioid overdose. Males are more to abuse drug substances than females (McHugh et al., 2020). The patient’s male gender may have contributed to the history of substance abuse.

 

References

McHugh, R. K. (2020). The Importance of Studying Sex and Gender Differences in Opioid Misuse. JAMA Network Open, 3(12), e2030676-e2030676. https://doi.org/10.1001/jamanetworkopen.2020.30676

Rzasa Lynn, R., & Galinkin, J. L. (2018). Naloxone dosage for opioid reversal: current evidence and clinical implications. Therapeutic advances in drug safety, 9(1), 63–88. https://doi.org/10.1177/2042098617744161

Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid Addiction, Genetic Susceptibility, and Medical Treatments: A Review. International journal of molecular sciences, 20(17), 4294. https://doi.org/10.3390/ijms20174294