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[ANSWERED] 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services

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.

Scenario: 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.

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.

Expert Answer and Explanation

Alterations in Cellular Process

Role of Genes in the Disease

According to a study done by McCance and Huether (2019), genetic variables contribute to the commencement of addictive substances and change from use to addiction. The authors also note that 40 to 60% of one’s vulnerability to substance use is accounted for by genetic factors. Another research by Muro (2018) found that PSD-95 is a specific protein gene that connects learning, memory, and addiction. The researchers also found that mice with a low rate of PSD-95 could not find their way out of the maze easily and were highly sensitive to cocaine. The study also found that a higher amount of PSD-95 gene made mice more sensitive to alcohol, nicotine, heroin, and morphine. Another gene that is responsible for addiction is the DARPP-32 gene. Abbasian, Lockington, Megharaj, and Naidu (2016) report that when DARPP-32 was extracted from mice, it failed to respond to hard drugs. Therefore, the 27-year-old is addicted to drugs because he inherited either DARPP-32 or PSD-95 from his family.

Reasons for Presenting Described Symptoms

Opioid overdose may cause effects, such as slow breathing, blue skin from poor blood circulation, small pupils, respiratory failure, lessened alertness, confusion, and loss of consciousness. This patient was unresponsive because he may have used opioid drugs in excess. The former is evident because he became responsive after receiving naloxone treatment. Naloxone is a non-addictive medication used to treat patients with opioid overdose to neutralize life-threatening depression of the respiratory system and central nervous system to allow the patient to regain normal breathing (Zhang, 2019). The medication only works when one’s body has opioid substances. The burning pain is the side effect of naloxone. The presence of necrotic tissue on the forearm and greater trochanter was due to fall when the patient was unconscious.

Physiologic Response

The physiological response is an involuntary reaction triggering a physical response to stimuli. An example of a physiologic response is fight or flight response. The physiological response can manifest itself through shaking, dry mouth, faster breathing, sweating, panic attacks, and heart palpitations. Abbasian et al. (2016) mention that one of the physiological responses to opioids is slowing the functions of the GI tract. Opioids may slow down the GT tract’s functioning by inhibiting the release of acetylcholine from the motor neurons. As a result, the victim may experience low excretion. Other physiological responses to opioid include dilatation of pupils, increased breathing, heart rate changes, and blood pressure, sweating, changes in body temperature and skin, and piloerection (Liu & Tang, 2020).

Cells Involved

Various cells are involved in physiological response. Dark, clear, and myoepithelial sweat cells are some of the cells involved in the process. When one feels the urge to abuse opioids, the brain will send a message to the cells above to produce sweat as a response. Other cells involved in the process are brown adipose tissue (BAT) and thermogenesis. These cells will either increase or reduce body temperature to respond to the urge to abuse opioids. The neurons in the hindbrain known as medulla and pons are the cells that regulate how one will breathe in the response of opioid stimulus (Liu & Tang, 2020). Overall, all these cells must be coordinated by the central nervous system.

How another Factor can Influence the Response

Genes will change how one response to opioids. For instance, a person with either DARPP-32 or PSD-95 will show physiological response symptoms when presented with opioids while the individual without the genes will not show any signs.

References

Abbasian, F., Lockington, R., Megharaj, M., & Naidu, R. (2016). A review on the genetics of aliphatic and aromatic hydrocarbon degradation. Applied biochemistry and biotechnology, 178(2), 224-250. https://link.springer.com/article/10.1007/s12010-015-1881-y

Liu, N., & Tang, M. (2020). Toxic effects and involved molecular pathways of nanoparticles on cells and subcellular organelles. Journal of Applied Toxicology, 40(1), 16-36. https://onlinelibrary.wiley.com/doi/full/10.1002/jat.3817

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

Muro, S. (2018). Alterations in cellular processes involving vesicular trafficking and implications in drug delivery. Biomimetics, 3(3), 19. file:///C:/Users/OnamMagy/Downloads/biomimetics-03-00019-v3.pdf

Zhang, W. C. (2019). U.S. Patent No. 10,287,296. Washington, DC: U.S. Patent and Trademark Office. https://patents.google.com/patent/US10287296B2/en

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