Last Updated on March 1, 2024 by Admin
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.
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 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.
Write an explanation of the disease highlighted in the scenario provided above. 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.
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
Pathophysiology for NP
Role of Genetics in the DiseaseStudies have found that genes play a huge role in determining whether one is going to be addicted to alcohol, nicotine, and other hard drugs. For instance, a study by Abbasian, Lockington, Megharaj, and Naidu (2016) showed that children whose parents were addicts are eight times more likely to be addicted to any of the hard drugs.
Reasons for Presenting the Symptoms
The patient became unresponsive because he may have used opioid substances in large quantity. This is evident because he became responsive after receiving naloxone. Zhang (2019) reports that naloxone is the drug used to lower the effects of an opioid in people who have consumed the substance in a large amount. The burning pain is the side effect of the opioid taken in large amounts.
Physiologic ResponseThe stimulus in this scenario is the naloxone. This drug has caused physiological response, and as a result, the patient was brought back to a responsive state. This response occurred when the drug triggered the patient’s heart and made it beat faster, and this made the patient wake up.
The Cells Involved The cells involved in this process are found in the brain. These cells are found in the brain reward system. The stimuli work by increasing the sensitivity to aversion in a move to reverse the effects of the opioid on the body. Some of the cells involved in the process are D 1-type medium spiny neurons and DeltaFosB (Liu & Tang, 2020). Genetics can change the response in that people with genes that support addiction will reduce the functions of the stimuli on the body.
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
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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FAQs
Rhabdomyolysis
Rhabdomyolysis is a rare but serious condition that occurs when muscle tissue breaks down and releases its contents into the bloodstream. The breakdown of muscle tissue results in the release of substances such as myoglobin, creatine kinase, and potassium into the bloodstream. These substances can cause damage to the kidneys and other organs.
Definition and explanation of rhabdomyolysis
Rhabdomyolysis is a medical condition in which muscle tissue breaks down and releases substances into the bloodstream. These substances include myoglobin, creatine kinase, and potassium, which can be harmful to the body in large quantities. The breakdown of muscle tissue can be caused by a variety of factors, including physical trauma, drug or alcohol abuse, infections, genetic muscle disorders, and extreme exertion such as in athletes.
The severity of rhabdomyolysis can range from mild to life-threatening, depending on the underlying cause and the extent of muscle damage. If left untreated, rhabdomyolysis can lead to complications such as kidney failure, electrolyte imbalances, and even death. Early diagnosis and treatment are crucial in preventing severe complications and improving outcomes.
Causes of rhabdomyolysis
Rhabdomyolysis can be caused by a variety of factors, including:
- Muscle injury: Muscle injury is one of the most common causes of rhabdomyolysis. When muscle tissue is damaged, the contents of muscle cells are released into the bloodstream, leading to the breakdown of muscle tissue. This can occur due to physical trauma, such as crush injuries, falls, or car accidents, as well as prolonged immobilization.
- Drug or alcohol abuse: Certain drugs and alcohol can cause rhabdomyolysis by damaging muscle tissue. Some drugs that have been associated with rhabdomyolysis include cocaine, amphetamines, and heroin. Excessive alcohol consumption can also lead to rhabdomyolysis.
- Infections: Certain infections can cause rhabdomyolysis, including viral infections such as influenza, bacterial infections such as sepsis, and parasitic infections such as malaria. Infections can cause muscle tissue to break down due to inflammation and damage.
- Heat stroke: Excessive exposure to heat can lead to rhabdomyolysis. This can occur when the body temperature rises to a dangerous level, leading to the breakdown of muscle tissue.
- Genetic muscle disorders: Certain genetic muscle disorders can cause rhabdomyolysis, including muscular dystrophy, myotonia, and metabolic myopathies. These conditions can lead to the breakdown of muscle tissue due to genetic abnormalities.
Symptoms of rhabdomyolysis
The symptoms of rhabdomyolysis can vary depending on the severity of the condition and the underlying cause. Some common symptoms of rhabdomyolysis include:
- Muscle pain, weakness, and swelling: Muscle pain, weakness, and swelling are often the first symptoms of rhabdomyolysis. The affected muscles may feel tender to the touch and may be accompanied by stiffness or cramping.
- Dark urine and decreased urine output: The breakdown of muscle tissue can lead to the release of myoglobin, a protein that can cause urine to appear dark or reddish-brown. Additionally, rhabdomyolysis can cause a decrease in urine output or even complete urine blockage due to the formation of kidney stones.
- Other possible symptoms: Other symptoms of rhabdomyolysis may include fatigue, nausea, vomiting, fever, confusion, and seizures. In severe cases, the condition can lead to kidney failure, electrolyte imbalances, and even death.
Diagnosis and treatment of rhabdomyolysis
Diagnosis of rhabdomyolysis usually involves a combination of blood tests and imaging studies. Blood tests are used to measure levels of creatine kinase (CK), myoglobin, and electrolytes, all of which can be indicators of muscle breakdown. Imaging studies such as ultrasound or MRI may be used to assess the extent of muscle damage and check for possible complications such as kidney damage.
The treatment of rhabdomyolysis primarily focuses on addressing the underlying causes of the condition and preventing complications. If the condition is caused by drug or alcohol abuse, stopping the use of the substance is essential. If the condition is caused by an infection, antibiotics may be prescribed to control the infection.
Supportive care is also important in treating rhabdomyolysis. This may involve hospitalization in severe cases to monitor kidney function, manage electrolyte imbalances, and prevent complications. Intravenous fluids may be given to prevent dehydration and to flush out the kidneys, while diuretics may be used to promote urine output and prevent the formation of kidney stones.
In cases where the condition is caused by a genetic disorder, specific treatments may be needed to manage the underlying condition. For example, physical therapy may be recommended to improve muscle strength and function in people with muscular dystrophy.
In summary, the treatment of rhabdomyolysis involves addressing the underlying causes of the condition, preventing complications, and providing supportive care. It is important to seek medical attention if you experience symptoms of rhabdomyolysis, especially if you have recently suffered a muscle injury, engaged in strenuous exercise, or taken medications that can cause muscle damage. Early diagnosis and treatment are crucial in preventing severe complications and improving outcomes.
Prevention of rhabdomyolysis
Preventing rhabdomyolysis involves taking measures to avoid muscle injury, limiting the use of drugs and alcohol, and implementing hydration and cooling measures during strenuous activities. Some key prevention strategies include:
- Avoiding muscle injury: To prevent muscle injury, it is important to engage in regular exercise to improve muscle strength and flexibility, warm up and stretch before exercise or other physical activity, and use proper technique when lifting weights or performing other strenuous activities. It is also important to rest and allow adequate recovery time between workouts or other physical activities.
- Limiting the use of drugs and alcohol: Certain drugs and alcohol can cause muscle damage and increase the risk of rhabdomyolysis. To prevent this, it is important to limit the use of drugs and alcohol and avoid using them in excess.
- Hydration and cooling measures: When engaging in strenuous activities such as exercise or manual labor, it is important to stay hydrated by drinking plenty of water and other fluids. Adequate hydration can help prevent muscle damage and rhabdomyolysis. Additionally, cooling measures such as taking breaks in a cool environment or using ice packs can help prevent overheating and further muscle damage.
- Monitoring medications: Certain medications can increase the risk of rhabdomyolysis, such as statins used to manage high cholesterol. To prevent this, it is important to monitor medication use and talk to a healthcare provider about any concerns.
In conclusion, rhabdomyolysis is a serious condition that can result in muscle damage, kidney failure, and other severe complications. It is important to understand the causes, symptoms, and treatment options for this condition to prevent serious health consequences.
People at risk for rhabdomyolysis, including those who engage in strenuous physical activity, have suffered a muscle injury, or take certain medications, should be aware of the symptoms of the condition and seek medical attention if they experience muscle pain, weakness, or dark urine.
Preventing rhabdomyolysis involves taking steps to avoid muscle injury, limiting the use of drugs and alcohol, and implementing hydration and cooling measures during physical activity. Early diagnosis and treatment are crucial in preventing severe complications and improving outcomes.
Ultimately, understanding rhabdomyolysis and taking steps to prevent the condition is essential for maintaining optimal health and preventing serious health consequences. If you are experiencing symptoms of rhabdomyolysis or are at risk for the condition, it is important to seek medical attention promptly to ensure the best possible outcomes.
Naloxone
Naloxone is a medication that has gained significant attention in recent years due to its critical role in reversing opioid overdose, a growing public health crisis. It is an opioid antagonist that rapidly reverses the effects of opioids, including heroin, fentanyl, and prescription painkillers, by binding to opioid receptors in the brain and blocking the effects of opioids.
Naloxone was first developed in the 1960s and was primarily used in hospital settings to reverse the effects of opioids during surgery or other medical procedures. Over time, its potential for use in treating opioid overdose became apparent, and naloxone was increasingly used in emergency situations to prevent overdose deaths.
In recent years, as the opioid epidemic has continued to grow and overdose deaths have increased, the use of naloxone has become even more critical. Governments, healthcare providers, and community organizations have implemented naloxone distribution programs to increase its availability and accessibility, and laws and regulations have been passed to make it easier to obtain naloxone.
Despite its widespread use, there is still much to learn about naloxone, including its optimal administration and dosing, potential side effects and risks, and its effectiveness in preventing overdose deaths. This paper will provide an overview of naloxone, including its mechanism of action, indications for use, forms of administration, potential side effects and risks, and accessibility.
Naloxone mechanism of action
Naloxone works as an opioid antagonist, meaning that it blocks the effects of opioids by binding to the same receptors in the brain and body that opioids target. When naloxone is administered, it rapidly displaces opioids from these receptors, preventing them from producing their characteristic effects.
Opioid receptors are found throughout the body, including in the brain, spinal cord, and peripheral organs such as the gastrointestinal tract. When opioids bind to these receptors, they activate a signaling pathway that produces a range of effects, including pain relief, euphoria, and respiratory depression. However, in overdose situations, these effects can become dangerous and potentially fatal, leading to respiratory arrest and death.
When naloxone is administered, it rapidly reverses these effects by binding to the opioid receptors and blocking the effects of opioids. This can rapidly restore breathing and consciousness in individuals experiencing opioid overdose. The effects of naloxone typically begin within minutes of administration and can last for up to several hours, depending on the individual and the dose administered.
In addition to reversing the effects of opioids, naloxone can also produce its own effects on the brain and body. Some of these effects may include anxiety, agitation, and withdrawal symptoms in individuals who are physically dependent on opioids. However, these effects are generally short-lived and are outweighed by the potential benefits of naloxone in reversing overdose and preventing death.
Overall, the mechanism of action of naloxone is a critical component of its effectiveness in treating opioid overdose and preventing fatalities. By rapidly blocking the effects of opioids in the brain and body, naloxone can save lives and help individuals recover from overdose.
Indications for naloxone use
The primary indication for naloxone use is to treat opioid overdose, which can occur as a result of using opioids such as heroin, fentanyl, and prescription painkillers. In cases of overdose, opioids can produce a range of dangerous effects, including respiratory depression, which can be life-threatening. Naloxone is used to rapidly reverse the effects of opioids and restore breathing and consciousness.
Naloxone is also used in the treatment of opioid dependence, as it can help to manage withdrawal symptoms and cravings associated with opioid use. In this context, naloxone is often combined with other medications, such as buprenorphine, to produce a more comprehensive treatment approach.
Additionally, naloxone is sometimes used in the management of post-operative pain. In these cases, it can be administered to help manage the respiratory depression that can occur as a side effect of opioid pain medications.
In recent years, there has been a growing interest in expanding the use of naloxone beyond these traditional indications. For example, some community organizations have implemented naloxone distribution programs to make the medication more widely available to individuals who may be at risk of overdose. Additionally, there has been increasing interest in using naloxone in emergency medical settings to help manage other forms of drug overdose, such as benzodiazepines or stimulants.
Overall, the indications for naloxone use are varied and continue to evolve as new research is conducted and new strategies for preventing opioid overdose are developed. However, the primary use of naloxone remains in the treatment of opioid overdose, which is a critical public health issue facing communities around the world.
Forms of naloxone
Naloxone is available in several different forms, each of which is designed for specific routes of administration and use. Some of the most common forms of naloxone include:
- Injectable naloxone: Injectable naloxone is the traditional form of the medication, and it is typically administered by healthcare professionals in hospital or emergency settings. It is available in vials or pre-filled syringes, and it is usually administered intravenously or intramuscularly.
- Intranasal naloxone: Intranasal naloxone is a newer form of the medication that is designed to be administered through the nose. It is available as a pre-filled nasal spray, and it is easy to use in emergency situations. Intranasal naloxone has become increasingly popular in recent years due to its ease of use and potential to be administered by non-medical personnel, such as family members or friends of individuals at risk of overdose.
- Auto-injector naloxone: Auto-injector naloxone is a relatively new form of the medication that is designed for self-administration in emergency situations. It is available as a pre-filled auto-injector device, which can be used by individuals who may be at risk of overdose or by their caregivers. Auto-injector naloxone is a promising new development in the field of opioid overdose prevention, as it has the potential to make naloxone more widely available and accessible to individuals who may need it.
Administration of naloxone
The administration of naloxone depends on the form of the medication being used. Here are the proper techniques for administering each form:
- Injectable naloxone: Injectable naloxone is typically administered by healthcare professionals in a hospital or emergency setting. Proper technique involves:
- Preparing the medication by drawing it up into a syringe (or using a pre-filled syringe)
- Administering the medication either intravenously (into a vein) or intramuscularly (into a muscle)
- Monitoring the individual closely for signs of overdose reversal and providing additional care as needed
It is important to note that injectable naloxone should only be administered by trained medical personnel, as it requires expertise in proper injection techniques and monitoring of the individual’s condition.
- Intranasal naloxone: Intranasal naloxone is a form of the medication that is administered through the nose. Proper technique involves:
- Assembling the pre-filled nasal spray according to the manufacturer’s instructions
- Administering the medication by inserting the nozzle of the nasal spray into one nostril and pressing down on the plunger to release the medication
- Administering a second dose of the medication in the other nostril after a few minutes if the individual does not respond to the first dose
- Monitoring the individual closely for signs of overdose reversal and providing additional care as needed
Intranasal naloxone is designed to be easy to use and can be administered by non-medical personnel, such as family members or friends of individuals at risk of overdose.
- Auto-injector naloxone: Auto-injector naloxone is a form of the medication that is designed for self-administration in emergency situations. Proper technique involves:
- Removing the auto-injector device from its packaging
- Activating the device by pressing it firmly against the individual’s outer thigh
- Holding the device in place for several seconds to ensure that the medication is fully administered
- Seeking additional medical attention and care as needed
Auto-injector naloxone is designed to be simple and easy to use, even for individuals who may be experiencing an overdose themselves. However, it is important to note that training and education on proper administration techniques are still recommended for optimal effectiveness and safety.
Potential side effects and risks of naloxone use
While naloxone is generally safe and effective, there are potential side effects and risks associated with its use. Some of the short-term side effects of naloxone may include headache, nausea, vomiting, sweating, tremors, rapid heartbeat, high blood pressure, and anxiety. These side effects are usually mild and temporary, and they typically subside within a few minutes to hours after administration.
In rare cases, more serious side effects may occur, such as seizures, heart rhythm disturbances, or an allergic reaction to the medication. If any of these symptoms occur, it is important to seek medical attention immediately.
There are also risks associated with using naloxone in individuals with certain medical conditions. For example, individuals with a history of heart disease, seizures, or other medical conditions may be at an increased risk for complications from naloxone use. Additionally, if naloxone is administered too quickly or in excessive amounts, it may cause an abrupt reversal of opioid effects, which can lead to symptoms of opioid withdrawal, such as agitation, nausea, and vomiting.
It is important to note that while naloxone can reverse the effects of an opioid overdose, it does not treat the underlying addiction or prevent future overdoses. Therefore, individuals who receive naloxone should seek medical attention immediately to address the underlying cause of the overdose and receive appropriate treatment and support for addiction.