Discussion: Alterations in Cellular Processes NURS 6501

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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

Discussion Alterations in Cellular Processes NURS 6501

Discussion Alterations in Cellular Processes NURS 6501

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.
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

Scenario 3: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

1. The role genetics plays in the disease. Some genetic factors that can play a part in malabsorption syndrome involve conditions that hinder digestion. These include chronic pancreatitis, Celiac disease, Crohn’s disease, and hereditary folate malabsorption. These genetic diseases cause an inflammatory process in certain parts of the Gi tract resulting in malabsorption of essential nutrients (Medline Plus, 2020).

2. Why the patient is presenting with the specific symptoms described. The patient presents with protein malnutrition characterized by an energy-deficient state caused by deficiencies of fat, carbohydrates, and protein, also known as macronutrients. The patient has a history of malabsorption syndrome, so the patient has difficulty absorbing protein. Their inadequate oral intake exacerbates the condition due to difficulty eating secondary to a lack of dentures.

Elderly individuals with chewing difficulties risk weight loss, poor nutrition, and increased mortality due to insufficient nutrition intake. Proper chewing of food is essential for adequate absorption of certain nutrients, primarily more substantial proteins (Keller & Layer, 2014). The patient’s poor nutrition results in a deficiency or low protein levels in the blood, causing abdominal edema similar to kwashiorkor’s extreme case.

3. The physiologic response to the stimulus presented in the scenario and why you think this response occurred. Due to protein deficiency or starvation, muscles start to atrophy leading to protein degradation (McCance & Huether, 2019). Albumin synthesis is decreased due to protein deficiency. Albumin plays a significant role in maintaining oncotic pressures within the blood vessels. Low albumin levels within the lumen allow for interstitial leakage of fluid, as presented by increased edema (Gounden, Vashisht, & Jialal, 2020).

4. The cells that are involved in this process. Immune cells are closely linked to metabolic changes caused by malnutrition. Malnutrition will influence cytokine levels, immune cell counts, and their effectiveness. Protein malnutrition diminishes the functionality of T-cells, neutrophils, and natural killer cells (McCance & Huether, 2019). There will also be a change in hormone activity and albumin levels.

5. How another characteristic (e.g., gender, genetics) would change your response. Insufficient enzyme production diseases can affect the absorption of macronutrients, including protein. Individuals who have pancreatic cancers, Crohn’s, inflammatory bowel diseases, and diabetes are some examples that can disturb the exocrine pancreas functions, which can worsen these physiological responses (Keller and Layer, 2014). Individuals with organ failure or deficiencies bring on higher demand for nutrients. This demand exacerbates the energy deficit compared to nutritional intake. Hypermetabolic conditions increase energy expenditure on the body and worsen the malabsorption physiology (Saunders & Smith, 2010).

References

Gounden, V., Vashisht, R., & Jialal, I. (2020). Hypoalbuminemia. StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526080/

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.

Medline Plus. (2020). Malabsorption Syndromes. https://medlineplus.gov/malabsorptionsyndromes.html

Saunders, J., & Smith, T. (2010). Malnutrition: causes and consequences. Clinical medicine (London, England), 10(6), 624–627. https://doi.org/10.7861/clinmedicine.10-6-624

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!

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
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)

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

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 
  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 
  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.

Scenario

A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Overview of diagnoses and genetics

Streptococcus pyogenes or strep throat is an acute bacterial infection that affects the oropharynx and nasopharynx. Strep throat presents as a sore throat, pain while swallowing, and a fever. Patients may also experience a headache, nausea, vomiting, or abdominal pain. The average incubation period is 1-4 days. The highest risk of transmission occurs during the acute stage when a patient coughs or sneezes. If untreated, patients may experience an acute rheumatic fever or glomerulonephritis (Al-Dewan, Al Saadi & Ali, 2020). This patient was treated with amoxicillin, a type of penicillin. The patient subsequently had an allergic reaction to the amoxicillin. While strep throat does not have a genetic component, a penicillin allergy does. Patients who have reported penicillin allergies can have a genetic variation on an immune system gene called HLA-B. Some patient’s HLA genes have been linked to bad reactions of specific drugs. The patients are predisposed to have a higher risk of allergic drug reactions (Erdmann, 2020).

Patient presentation and physiologic response

The patient is presenting with symptoms of low-grade fever, reddened posterior pharynx with white exudate, 3+ tonsils, and enlarged cervical lymph nodes. These are symptoms of strep throat. The patient is presenting this way because he contracted bacteria through the mucus membranes and the infection invaded, multiplied, and disseminated. The patient had an unknown and underlying drug allergy to penicillin; therefore, he had an allergic reaction to penicillin. The patient had a type 1 or beginning of an anaphylactic reaction. IgE antibodies were produced in response to the medication components. These antibodies (IgE) bind to mast cells and basophils, which contain histamine granules that are released in the reaction and cause inflammation (Justiz-Vaillant & Zito, 2019). The cells involved in this process are eosinophils, mast cells, and basophils. The patient may have had a genetic predisposition to allergies as if his parents had an anaphylactic allergic response to penicillins then a provider may be cautious to prescribe penicillin as well.

References

Al-Dewan, H. A., Al Saadi, K. A., & Ali, H. H. M. (2020). Role of superantigen A gene on some immunological markers in the streptococcal pharyngitis patients. EurAsian Journal of Biosciences14(2), 7603–7612.

Erdmann, J. (2020). Penicillin allergies may be linked to one immune system gene. Science News. https://www.sciencenews.org/article/penicillin-allergies-immune-system-genetics. 

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In Stat-Pearls. Treasure Island, FL: StatPearls Publishing. Retrieved from

n Post

The case presented is a 16-year old boy with strep throat. This was suspected based on presenting symptoms of reddened posterior pharynx with white exudate on tonsils, swelling of tonsils, and anterior and posterior cervical adenopathy. This was confirmed by a rapid strep test. All of this presents as a common diagnosis of strep throat, and the healthcare provider prescribed the typical course of treatment. However, the patient experiences an immediate reaction to the medication and needs to be given emergency treatment for his allergic reaction. While there are no known factors that can predict amoxicillin allergy in children, a family history of a drug allergy may indicate a potential allergy (Faitelson et al., 2018). Family history was not presented in the case study; however, it was noted that the patient himself exhibited no known drug allergies, therefore there was no reason to suspect this patient would have an allergic reaction to the amoxicillin. After taking the amoxicillin, the patient is presenting with an immediate hypersensitivity reaction (Justiz-Vaillant & Zito, 2019; McCance & Huether, 2019; Soo, 2018).

Strep throat is caused by streptococcus bacteria, which is spread through droplet contact. Streptococcal pharyngitis has a short incubation period and presents as red, painful throat, swollen and pus-filled tonsils, enlarged cervical lymph nodes, and fever (Thai et al., 2018). The inflammation present in the tonsils is a result of the body’s immune response. The exudate present on the tonsils also results from the body’s immune response, as the pus contains dead cells, tissues, and bacteria as byproducts of phagocytosis (McCance & Huether, 2019; Soo, 2018).

There is a strong genetic link regarding IgE response to antigens or allergens (Soo, 2018). The case study presented no known drug allergies for the patient but does not list family medical history, so this information is not known. Most diseases, even when a genetic component is present, have both genetic and environmental aspects (McCance & Huether, 2019). While females are more susceptible to experiencing autoimmune disorders, the type I immediate hypersensitivity immune reaction presented in this case study does not fall under that category (McCance & Huether, 2019; Soo, 2018). One consideration for genetic factors is the increased serum tryptase levels in those with alpha tryptasemia. Individuals with alpha tryptasemia experience hypersensitive reactions and are often associated with systemic mastocytosis conditions (Macharadze, 2021). This information is not presented in this case study and is therefore unknown at this time.

This patient is experiencing an immediate hypersensitivity reaction to the amoxicillin medication, which is a type I or anaphylactic response (Justiz-Vaillant & Zito, 2019). When the patient ingested the amoxicillin, the body viewed the drug as an antigen. Upon exposure to the antigen, B cells mature into plasma cells, which produce IgE antibodies. These IgE antibodies then bind to specific receptors on mast cells, which then degranulate and release pro-inflammatory mediators, including histamine (Soo, 2018). Histamine causes vasodilation and subsequent hypotension, bronchoconstriction, and increased vascular permeability (McCance & Huether, 2019). The increased vascular permeability allows for fluid to leave the vasculature and enter the interstitial space, resulting in inflammation, which was evidenced by the patient experiencing swelling in his tongue and lips. The production of histamine also resulted in bronchoconstriction, which presented in difficulty breathing and auditory wheezing in the patient (McCance & Huether, 2019; Soo, 2018). The difficulty breathing may have also been exacerbated by an inflammatory response in the throat, as the patient was also experiencing swollen tongue and lips.

References

Faitelson, Y., Boaz, M., & Dalal, I. (2018, July). Asthma, family history of drug allergy, and age predict amoxicillin allergy in children. Journal of Allergy and Clinical Immunology, 6(4), 1363-1367.

Justiz-Vaillant, A. A. & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. StatPearls Publishing.

Machardze, D. S. (2021, December). Mast cells and tryptase. Modern aspects. Medicine Immunology, 23(6), 1271-1284.

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

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file].

Thai, T. N., Dale, A. P., & Ebell, M. H. (2018, June). Signs and symptoms of group A versus non-group A strep throat: A meta-analysis. Family Practice, 35(3), 231-238.

NURS_6053_Module03_Week06_Assignment_Rubric

Excellent Good Fair Poor
Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

·   A description of your core values.
·   A personal mission/vision statement.

Points Range: 14 (14%) – 15 (15%)
The response accurately and thoroughly describes in detail a set of core values.

The response accurately and completely describes in detail a personal mission/vision statement.

Points Range: 12 (12%) – 13 (13%)
The response describes a set of core values.

The response describes a personal mission/vision statement.

Points Range: 11 (11%) – 11 (11%)
The response describes a set of core values that is vague or inaccurate.

The response describes a personal mission/vision statement that is vague or inaccurate.

Points Range: 0 (0%) – 10 (10%)
The response describes a set of core values that is vague and inaccurate, or is missing.

The response describes a personal mission/vision statement that is vague and inaccurate, or is missing.

·   Analysis of your CliftonStrengths Assessment summarizing the results of your profile.
·   A description of two key behaviors you wish to strengthen.
Points Range: 14 (14%) – 15 (15%)
The response accurately and completely provides an analysis and detailed summary of the CliftonStrengths Assessment.

The response accurately and thoroughly describes in detail two key behaviors to strengthen.

Points Range: 12 (12%) – 13 (13%)
The response accurately provides an analysis and summary of the CliftonStrengths Assessment.

The response describes two key behaviors to strengthen.

Points Range: 11 (11%) – 11 (11%)
The response provides an analysis and summary of the CliftonStrengths Assessment that is vague or inaccurate.

The response describes two key behaviors to strengthen that is vague or inaccurate.

Points Range: 0 (0%) – 10 (10%)
The response provides an analysis and summary of the CliftonStrengths Assessment that is vague and inaccurate, or is missing.

The response describes two key behaviors to strengthen that is vague and inaccurate, or is missing.

·   A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
Points Range: 50 (50%) – 55 (55%)
An accurate, complete, and detailed development plan is provided that thoroughly explains plans to improve upon the two key behaviors selected.

The responses accurately and thoroughly explain in detail plans on how to achieve a personal vision with specific and accurate examples.

The response includes a comprehensive synthesis of information gleaned from sources that fully support how to achieve a personal vision. Integrates 2 or more credible outside sources, in addition to 2 or 3 course-specific resources to fully support the responses provided.

Points Range: 44 (44%) – 49 (49%)
An accurate development plan is provided that explains plans to improve upon the two key behaviors selected.

The responses explain plans on how to achieve a personal vision and may include some specific examples.

The response includes a synthesis of information gleaned from sources that may support how to achieve a personal vision. Integrates 1 credible outside source, in addition to 2 or 3 course-specific resources which may support the responses provided.

Points Range: 39 (39%) – 43 (43%)
A development plan is provided that explains plans to improve upon the two key behaviors selected that is vague or inaccurate.

The responses explain plans on how to achieve a personal vision and may include some examples that are vague or inaccurate.

The response includes information gleaned from 2 or 3 sources that may support how to achieve a personal vision.

Points Range: 0 (0%) – 38 (38%)
A development plan is provided that explains plans to improve upon the two key behaviors selected that is vague and inaccurate, or is missing.

The responses explain plans on how to achieve a personal vision that is vague and inaccurate, does not include any examples, or is missing.

The response does not include any additional information gleaned from outside sources, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100

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