Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

In this case study we have a 27-year patient who has a history of substance abuse. The patient was found unresponsive. Was successfully revived by emergency services (EMS). They are experiencing a burning pain, in their hip and forearm. Upon evaluation in the emergency department (ED) it was observed that there is tissue, over the greater trochanter and forearm. Additionally, abnormalities were detected in the EKG and serum potassium level. All these symptoms and findings indicate an interaction of factors including genetics substance abuse and cellular processes. Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

Role of Genetics

The genetic makeup of an individual can have an impact on their vulnerability to illnesses (Lemus et al., 2020). In this scenario the patient’s genetic composition might influence how their body reacts to substance abuse and resulting metabolic disruptions. Genetic factors can affect drug metabolism, addiction susceptibility and individual differences in regulating ion channels. These factors could potentially contribute to the observed imbalances in electrolytes.

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Patient’s Symptoms

The patient’s symptoms can be attributed to two factors; levels of potassium, in the blood (hyperkalemia) and breakdown of muscle tissue (rhabdomyolysis). Hyperkalemia, which is characterized by increased levels of potassium in the blood can cause abnormalities in heart function such as a prolonged PR interval (Lemus et al., 2020). The burning pain felt over the hip and forearm could be due to the presence of tissue which indicates rhabdomyolysis. This condition occurs when muscle tissue breaks down and releases myoglobin into the bloodstream potentially causing damage to tissues and affecting kidney function (Lemus et al., 2020). Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

Physiologic Response

The physiologic response in this scenario is likely multifaceted. Substance abuse can lead to altered cellular metabolism and electrolyte imbalances (Nlandu et al., 2022). In this scenario the patients past of substance abuse might have caused rhabdomyolysis by harming the muscle cells. Rhabdomyolysis combined with metabolic imbalances resulting from substance abuse could cause increased potassium levels leading to hyperkalemia (Nlandu et al., 2022). The release of myoglobin from damaged muscle cells can contribute to kidney damage, further exacerbating electrolyte imbalances.

Cells Involved

The main cells engaged in this process are the cells found in muscles and the cells found in the heart. When individuals abuse substances especially stimulants or certain drugs it can cause activity in the muscles which can potentially result in muscle breakdown. The release of myoglobin by muscle cells can build up in the bloodstream, potentially leading to kidney damage (Lugo-Fagundo et al., 2022). On the hand, cardiac cells may experience abnormalities in conduction and repolarization due to imbalanced levels of electrolytes such, as potassium. These abnormalities can be observed on an electrocardiogram (EKG) as a prolonged PR interval. Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

Impact of Other Characteristics

The response to substance abuse and the cellular processes that follow can be influenced by factors such as gender and genetics. According to Nlandu et al (2022), genetic makeup can play a role in determining how susceptible an individual is to addiction and their capacity to metabolize drugs. Furthermore, the severity of rhabdomyolysis and the subsequent release of myoglobin may be influenced by gender related discrepancies, in muscle mass and hormonal regulation. Additionally, variations in makeup could play a role, in affecting ion channel regulation, which in turn impacts the symptoms associated with hyperkalemia.

Conclusion

The case discussed here brings attention to the connection between genetics, substance abuse and cellular processes that result in hyperkalemia and rhabdomyolysis. It is essential for Advanced Practice Registered Nurses (APRNs) to have an understanding of these processes in order to deliver care educate patients about the potential risks of substance abuse and assist them in developing appropriate treatment strategies that address both the immediate symptoms and the underlying cellular changes contributing to the illness. Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

                                                            References

Lemus, R., Craver, A., Beebe, A., Samora, W., & Tobias, J. D. (2020). Etiology and Treatment of Intraoperative Hyperkalemia During Posterior Spinal Fusion in an Adolescent. Journal of Medical Cases, 11(6), 152.

Lugo-Fagundo, E., Lugo-Fagundo, C., Weisberg, E. M., & Fishman, E. K. (2022). CT of rhabdomyolysis as a sequela of drug abuse. Radiology case reports, 17(12), 4727-4729.

Nlandu, Y. M., Engole, Y. M., Mboliassa, M. F. I., Sakaji, T. J. M., Kobo, P. U., Boloko, P. M., … & Bukabau, J. B. (2022). Case Report Ineffectiveness of Intermittent Hemodialysis in a Critically Ill COVID-19 Patient: A Case of Persistent Heparin-Induced Hyperkalemia

INSTRUCTIONS:

The initial post above is MY POST which will be a guide for you to respond to POST 1 and POST 2 below. Please respond to POST 1 AND POST 2 below SEPERATELY and each of them should have three  references.

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. Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

                                                                      POST 1

The role genetics plays in disease.

Rhabdomyolysis is known as severe skeletal and muscular damage. It may cause heart rhythm disturbances, hypovolemic shock, disturbances of electrolyte balances, renal failure, etc. Its diverse etiologies are affected by genetics known as metabolic muscle disorders, mitochondrial disorders, muscular dystrophies, and intramuscular calcium release coupling. In some cases, RM may be affected by environmental causes and genetic predisposition. Those environmental causes are drug use, ethanol, infections, extreme physical exertion, crush injuries, compartment syndrome, ischemia, metabolic disturbance, idiopathic, and primary neurological disorders (Scalco et al., 2015).

Why is the patient presenting with the specific symptoms described?

The symptoms of hyperkalemia, tissue necrosis, and muscle pain presented the disease Rhabdomyolysis. As the muscle breaks down, the body releases potassium, which results in hyperkalemia. Potassium serum levels above 6.5 result in heart problems such as prolonged PR intervals and peaked T levels (Professional, n.d.). The patient in this scenario had a potassium level of 6.9, which explains the symptoms that they were experiencing.  Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The stimulus in this scenario was naloxone. Naloxone is a medication that is used to reverse opioid overdoses rapidly. It only affects someone who has opioids in their system, such as heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine (Naloxone DrugFacts | National Institute on Drug Abuse, 2023). Since this patient was unresponsive and had a history of substance abuse, the dose of naloxone helped the patient regain consciousness.

The cells that are involved in this process.

Normal muscle ion channels maintain low intracellular Na+ and Ca+ concentrations and high K+ within the muscle fiber. When muscle depolarization occurs, it increases Ca+, causing the muscles to constrict through actin-myosin. This depends on ATP availability; therefore, any damage is done to the ion channels through injury. This results in low ATP for energy and can disrupt the electrolyte concentrations (Torres, 2015).

How would another characteristic (e.g., gender, genetics) change your response?

As stated above, RM can occur from extensive exercise and drug use. This patient is 27 years old and could have just come from having a workout and experienced RM. Exercise can cause RM when your muscles lack time to heal and recover from an intense workout. Intense workouts include marathon runners, spin classes, and high-intensity interval training. Pushing yourself too hard without rest periods may increase your risk of RM (Professional, n.d.).  Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

References

Naloxone DrugFacts | National Institute on Drug Abuse. (2023, May 31). National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/naloxone

Professional, C. C. M. (n.d.). Hyperkalemia (High Potassium). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15184-hyperkalemia-high-blood-potassiumLinks to an external site.

Professional, C. C. M. (n.d.). Rhabdomyolysis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis

Scalco, R., Gardiner, A., Pitceathly, R. D. S., Zanoteli, E., Becker, J., Holton, J. L., Houlden, H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a genetic perspective. Orphanet Journal of Rare Diseases, 10(1). https://doi.org/10.1186/s13023-015-0264-3Links to an external site.

Torres, P. A. (2015, January 1). Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365849/

Zhang, M. (2011). Rhabdomyolosis and its pathogenesis. World Journal of Emergency Medicine, 3(1), 11. https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.01.002 Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

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                                                             POST 2

The scenario presented appears to be indicative of rhabdomyolysis, a condition characterized by the breakdown of muscle tissue, leading to the release of intracellular components into the bloodstream (Huether & McCance, 2019). Genetic predisposition can play a role in this condition, as certain genetic factors influence muscle metabolism and susceptibility to muscle breakdown (Huether & McCance, 2019).

The patient’s complaints of burning pain over the left hip and forearm are consistent with the myalgias often associated with rhabdomyolysis (Huether & McCance, 2019). The presence of necrotic tissue over the greater trochanter and forearm likely indicates muscle damage. The elevated serum potassium level and EKG changes, such as prolonged PR interval and peaked T waves, suggest hyperkalemia, a common complication of rhabdomyolysis (Huether & McCance, 2019). Posterior Spinal Fusion in an Adolescent Essay Discussion Paper

The physiological response to muscle breakdown in rhabdomyolysis involves the release of myoglobin, potassium, and other intracellular contents into the bloodstream (Huether & McCance, 2019). Myoglobin can lead to renal vasoconstriction and nephrotoxicity, contributing to acute kidney injury. The release of intracellular potassium can result in cardiac electrophysiological disturbances, explaining the EKG findings (Huether & McCance, 2019).

The cells primarily involved in this process are the damaged muscle cells, or myocytes, which release myoglobin and potassium into the bloodstream (Huether & McCance, 2019).

Considering gender as another characteristic, it could influence the expression and severity of rhabdomyolysis. Hormonal and physiological differences between genders may affect muscle metabolism and response to stressors such as substance abuse (Huether & McCance, 2019).

The initial post above is MY POST which will be a guide for you to respond to POST 1 and POST 2 below. Please respond to POST 1 AND POST 2 below SEPERATELY and each of them should have three references.

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. Posterior Spinal Fusion in an Adolescent Essay Discussion Paper