PART 1: Respond to these discussion question responses in at least 125 words/reference for each. Responses to classmates should either add to their original thinking, ask a probing question, or highlight another source of the literature that adds to the depth and breadth
of the discussion.
1. Sickle cell disease (SCD) is a genetic, inherited hemolytic disorder that most commonly affect African, Indian, and people of Arab ancestry. SCD is an autosomal-recessive genetic disorder that approximately affects more than 100,000 people solely in the US and millions internationally. Variants of SCD is caused from the presence of a mutated form of hemoglobin. The presentation of SCD, red blood cells are viscose and produced in the shape of sickle or “c” shape. Due to the shape of the RBC’s in SCD, red blood cells are smaller and are not able to carry the same amount of oxygen throughout the body as normal RBC’s would. Whereas, the sickle like shape, RBC’s are not as flexible and cannot freely move through the bloodstream, therefore often causing vaso-occlusive events. Blockages from vaso-occlusive events often result in painful episodes.
In normal bodily pathological function, healthy red blood cells on average live up to 120 days. However, sickle cell shaped blood cells only survive on average 10-20 days. With less amount of healthy RBC’sto circulate the body results in decreased oxygenation. According to information stated on John Hopkins Medicine, sickle cells may also be destroyed by the spleen (Sickle Cell Disease, n.d.). The function of the spleen aids to filter blood of infections. On the contrary, with reduced amount of RBC’s in circulation, results in patients becoming severely anemic.
Symptoms of sickle cell crisis can also be triggered by environmental factors. Environmental factors such as weather, high altitude, pollution, strenuous exercise, socioeconomic disparities (poor health), stress can attribute to the onset and or severity of manifestations of sickle cell crisis (Tewari Brousse, Piel, Menzel,Rees, 2015).
Treatments options for SCD lays within the confines of being treated with hydroxyurea, blood transfusions, and management of reducing triggers of sickle cell crisis. Currently under research is hematopoietic stem cell transplant is an option for patients with SCD, yet due to mismatch donor registry many patients are not candidates (Abraham, Jacobson, Bollard, 2016). The next wave of therapies becoming available are cell and gene editing approaches.
2. Inherited multifactorial disorders are caused by the influence of multiple gene mutations along with environmental factors (Norris, 2019). The most common birth defect congenital disorder that can be linked to environmental factors is a cleft lip and or cleft palate (Norris, 2019). It can occur isolated, combined in various combinations, or along with other congenital deformities including congenital heart diseases (Vyas et al., 2020). The appearance of the disorder is dependent on environmental changes in addition to genetic mutations (Norris, 2019).
Environmental factors attributed to cleft lip and palate include teratogens such as anticonvulsant drugs, smoking both passive and active, alcohol, and socioeconomical factors during fetal development (Goveas & Savitha, 2017). Socioeconomimical factors include those without the means for prenatal care due to lack of healthcare options, improper nutrition, or living and or working environments that may lead to exposure to hazardous materials (Goveas & Savitha, 2017).
Babies with a cleft lip can usually nurse without issue; those with the cleft palate require specialized bottles for feeding (Norris, 2019). Dental problems can occur including delay in tooth maturation, speech difficulties, and ear infections due to the improper function of the muscle that opens the Eustachian tube (Vyas et al., 2020). These ear infections can lead to hearing loss (Vyas et al., 2020)
Surgical repair of a cleft lip will be more for aesthetics and to not bring attention to the defect whereas surgical repair of a cleft palate is more for functional purposes (Vyas et al., 2020). Surgical intervention needs to be done at the right time to prevent any developmental delays (Vyas et al., 2020). Surgical closure of the lip is usually performed by 3 months of age with the closure of the palate at one year of age (Norris, 2019). Folic acid is recommended to be supplemented during pregnancy to prevent neural tube defects especially in those who may be a high risk (Argyridis, 2019).
3. The U.S. Preventive Services Task Force (USPSTF) published a statement regarding their recommendation for intervention to prevent illicit drug use in the primary care setting. The population of focus is children, adolescents, and young adults twenty-five years old and younger. The objective was to review evidence from different studies to see if there were any benefits or harms regarding primary care interventions used to prevent initiation of illicit drug use in this population. USPSTF reviewed a total of twenty-nine studies. These studies included interaction on computers, printed material, and group and individual counseling to name a few. Interventions included education about illicit drugs, self-esteem, managing stress, refusal, and social skills. Illicit drug use outcomes were reviewed and were inconsistent. Therefore, the UPSTF concluded there was insufficient evidence regarding the harm or benefit of intervention to prevent illicit drug use at the primary-care level for children, adolescents, and young adults. Their recommendation is consistent with their statement made in 2014. Although there is insufficient evidence, USPSTF states that providers must be aware of illicit drug use signs and symptoms and recommend treatment when appropriate. On the other hand, The American Academy of Pediatrics recommends providers screen for illicit drug use and alcohol. Furthermore, they recommend interventions such as counseling, guidance, and treatment when appropriate. Positive reinforcement is recommended when no illicit drug or alcohol use is noted. Likewise, the Substance Abuse and Mental Health Services Administration recommend that screening be a part of routine health visits. They also recommend interventions that help prevent or reduce substance use (U.S. Preventive Services Task Force, 2020).
Acetaminophen Pathophysiological Effects on the Neurological System
Acetaminophen is the most commonly used over-the-counter medication. Although it is considered safe, acetaminophen remains a significant cause of overdose, poisoning, and death in the United States (Burns et al., 2020). Acetaminophen is also called N-acetyl para-aminophenol that is an analgesic and antipyretic agent. It is used to treat pain and reduce fevers. Its mechanism of action is unclear but is thought to work by inhibiting cyclooxygenase (COX) pathways in the nervous system. The reduction of the COX pathway, in turn, inhibits the synthesis of prostaglandins and thus produces antipyretics and analgesic effects. Furthermore, it is thought that the analgesic effects could be due to activation of the descending serotonin pathways, and it is also thought that its metabolites stimulate the cannabinoid system (Gerriets et al., 2021). Treatment for acetaminophen poisoning is with the antidote N-acetylcysteine. The key to treatment is to start before the onset of liver injury, which is evident by elevated alanine aminotransferase (ALT). Other adjunct therapies include cimetidine and extracorporeal removal (Heard & Dart, 2020).
Pain Management Differences in Special Populations
There are many differences between special populations, such as pediatric and geriatric populations. One difference between the pediatrics and geriatric population is the pharmacokinetics and pharmacodynamics effects of drugs for pain management (Fernandez et al., 2011). Fernandez et al. (2011) state pharmacokinetics “studies the passage of the drugs through the organism, this means liberation, absorption, distribution, metabolism and excretion” (p. 54). They also define pharmacodynamics as ” the relationship between drug dosage and effect in a certain organ or system” (p.54). The Pharmacokinetic process in neonates, infants, children, adolescents, and older adults differs. Fernandez et al. (2011) review further illustrate that metabolism, absorption, excretion, and plasma protein binding are generally reduced in the pediatric population compared to older adults. Likewise, Norris (2019) gives an example such as infant’s hepatic enzymes are reduced, leading to decreased metabolism of certain drugs. Norris (2019) also states that many analgesics used for adults can be used for children. However, when choosing a pharmacological drug, it must be appropriate for the child’s physiological development. It is also essential to make sure the pharmacological drug is approved for use in children. Lastly and most importantly, the pharmacological drug must be dosed appropriately based on the child’s weight.
4.The United States Preventive Services Task Force (USPSTF) understands that, due to inconsistencies in studies, more research is needed regarding successful interventions for children and adolescents using illicit drugs (2020). Behavioral counseling is a prevention strategy that was studied. The results were mixed with no significance regarding it’s benefit to the subjects; in fact, there were a few reports of an increase in illicit drugs use after preventative counseling while there were others reporting success or no change. In children and adolescents aged 12-17 years of age, it is not recommended to screen this population for unhealthy alcohol or drug use due to insufficient evidence (2020). Primary care interventions include encouraging cessation, counseling, and referral. Although the USPSTF does not have enough evidence to recommend or go against interventions to prevent illicit drug use in this population, it remains that we should be alert to signs and symptoms of illicit drug use and intervene if appropriate.
Choose a common overdose drug other than opioids and briefly discuss the pathophysiological effects on the neurological system.
Alcohol is ingested by mouth in most instances. When the alcohol reaches the gastrointestinal tract, it has the ability to pass through the endothelial cell wall in filter into the capillaries of the body (Schwartz-Bloom et al., n.d.). From the capillaries, the ethanol enters the blood stream where it makes its way to the brain. Being lipophilic, the ethanol passes through the blood-brain barrier where it causes disruption in the brain cell function and decreases excitation within the central nervous system. Ethanol suppresses excitatory pathways in the central nervous system, leading to neuro-cognitive deficits that play a factor in motor vehicle accidents and acts of violence; it is a dangerous drug. In high enough amount, alcohol is lethal.
Alcohol is metabolized in the liver, but the byproducts of this metabolism are known as free radicals, which are toxic to the liver (NIH, 2007). According to Dr. Norris, “In cells and tissues, free radicals react with proteins, lipids, and carbohydrates, thereby damaging cell membranes; inactivate enzymes; and damage nucleic acids that make up DNA.” (Norris, 2019). This type of reaction by free radicals leads to disruption and damage of cells and tissues. Accumulation of these free radicals can lead to alcoholic hepatitis, fibrosis, cirrhosis, and death.
Identify at least one difference between the considerations for pediatric patients versus geriatric patients in regard to pain management.
Regarding pain management, pediatric patients are known to accurately and reliably report pain while the older adult may be reluctant to report pain (Norris, 2019). The older adult may show hesitancy to report pain out of fear or feeling like he or she is a burden.
PART 2: respond to this prompt:
This case scenario takes you through a visit with an adult patient, Mrs. Q, who has come to the hospital because she was having trouble moving her right arm. Use the information provided to complete your assignment.
Mrs. Q is a 66-year-old female who was gardening with her husband. All of a sudden, she was having trouble moving her right arm. Her husband asked her if she was okay and found that she was not able to speak clearly. He could not lift her up or get her to stand up. He quickly called an ambulance; the EMTs came and picked her up from the garden and transferred her to the hospital.
Mrs. Q is admitted to the emergency department with facial droop, arm weakness, and dysarthria in the last 2 hours. She is having difficulty speaking and is unable to move any of her right-sided extremities. She is complaining of severe headache. She is incontinent of urine and feces. She weighs 302 lbs.
Patient has a new diagnosis of stroke and supraventricular tachycardia (SVT)
What possible learning needs would you anticipate for this patient?
What cultural and age-related factors might have a bearing on the patient’s plan of care? Include bariatric considerations
