ANSWERED!! 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

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.

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.

Rubric Detail

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Name: NURS_6501_Discussion_Rubric

	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.
Total Points: 100

Name: NURS_6501_Discussion_Rubric

Expert Answer and Explanation

Alterations in Cellular Process

Role of Genes in the Disease

Genes play a significant role in substance use and addiction. McCance and Huether (2019) argue that certain genes can lead to substance use to substance addiction. The authors note that genetic factors account for 40% to 60% of vulnerability to addiction. One of the genes that often impact substance addiction is PSD-95 (Muro, 2019). The author argues that this gene is known for connecting addiction, memory, and learning. Muro (2019) conducted with mice to find the impact of PSD-95 on addiction. The authors found that the mice with a low rate of PSD-95 could not get out of the maze; instead, they went where cocaine was placed. The study concluded that mice with a higher rate of PSD-95 were highly sensitive to heroin, alcohol, cocaine, nicotine, and morphine. It can be concluded that the patient in the case scenario has a low number of PSD-95 genes making him more sensitive to hard drugs.

Reasons for Presenting Described Symptoms

The 27-year-old may have abused opioids and thus experienced unresponsiveness. According to Zhang (2019), opioid overdose can cause blue skin due to poor blood circulation, slow breathing, lessened alertness, respiratory failure, small pupils, loss of consciousness, and confusion. The authors also note that a person who has been unresponsive from taking opioids can be made conscious by giving them naloxone medication. The medication can neutralize the life-threatening depression of the central nervous and respiratory systems to regain normal breathing. The argument is evident because the patient was given naloxone and became responsive. The medication works only on people with opioid overdose. The burning pain experienced by the patient is a side effect of the naloxone. The patient fell after being unconscious, and thus he developed necrotic tissue on the greater trochanter and forearm. Serum potassium level 6.9 mEq/L shows that the patient has moderate hyperkalemia.

Physiologic Response

A physiological response can be defined as the body’s response to stimuli when in a stressful situation. Flight and fight are some of the examples of physiological response. The responses can manifest through the dry mouth, shaking, sweating, heart palpitations, panic attacks, and after breathing (Murach, Dungan, Peterson & McCarthy, 2019). The serum potassium level 6.9 mEq/L shows the effects of the opioid on the kidney. Opioids can affect the kidney by increasing the rate of potassium in the kidney. To respond to these stimuli, the patient’s body reacted by impacting his respiratory and circulatory system. Therefore, the patient lost consciousness and became unresponsive. The burning sensation was the body’s physiological response to naloxone.

Cells Involved

Clear, dark, and myoepithelial sweat cells are involved in sweat response. When the patient wants to abuse opioids, the brain will send the message to the above cells, which will then trigger sweating. The skin is also involved in a burning sensation (Murach et al., 2019). The brain’s response to naloxone often sends a message to the nerves in the skill; hence resulting in a burning sensation. Other cells involved in physiological response include brown adipose tissue (BAT) and thermogenesis.

How another Factor can Influence the Response

Genes can change the physiological response to the above stimuli. For instance, individuals with PSD-95 will be less sensitive to opioids and other hard drugs than people with a high number of PSD-95. Also, a patient without the DARPP-32 gene may not respond to opioid addiction (Abbasian, Lockington, Megharajm & Naidu, 2016).

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

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

Murach, K. A., Dungan, C. M., Peterson, C. A., & McCarthy, J. J. (2019). Muscle fiber splitting is a physiological response to extreme loading in animals. Exercise and sport sciences reviews, 47(2), 108. doi: 10.1249/JES.0000000000000181

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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