please respond why you agree or disagree with her discussion.
Discussion One
This case has many different factors that could have led to this event. In any medical assessment, you never want to assume anything. You want to look at the facts and dissect the situation. After reading through the scenario, the patient was determined to have overdosed on a medication that naloxone was able to reverse. Naloxone is used when a suspected overdose of opioids has occurred and is effective only in reversing opioids (National Institute on Drug Abuse, 2022). This use of naloxone concludes that the patient had overdosed on opioids because he became responsive after its administration.
The diagnosis that comes to mind after much research is rhabdomyolysis. Rhabdomyolysis can result from an overdose of opioids and lead to muscle necrosis and acute kidney injury which can cause hyperkalemia (McCance & Huether, 2018; O’Carroll & Fenwick, 2020). Rhabdomyolysis can account for the specific symptoms this patient has such as hyperkalemia and tissue necrosis. This started the physiological changes in his body once the overdose occurred. Genetics can play a factor in the likelihood of rhabdomyolysis occurring. Genetic causes include deficiencies in lipid metabolism, carbohydrate metabolism, and purine metabolism (McCance & Huether, 2018, p. 1431). In this case, however, the drug overdose is what induced the episode of rhabdomyolysis.
A genetic condition that would have changed my response is if the patient had a history of Addison’s or hypoaldosteronism, as this can also lead to hyperkalemia (McCance & Huether, 2018, p. 117). Rhabdomyolysis can occur in any age or gender but has a higher tendency to occur in men between the ages of 10 and 60 with a high BMI (Cabral et al., 2020). Age or gender would not have affected the decision of rhabdomyolysis as the final diagnosis.
When rhabdomyolysis occurs, muscle tissue begins to break down, leading to myoglobin and other intracellular contents being spilled into the extracellular space and then the bloodstream because the permeability of the cell wall increases (McCance & Huether, 2018, p. 1430). This unstable environment can then lead to the hyperkalemia the patient was experiencing as potassium is also allowed to cross over into the bloodstream (McCance & Huether, 2018, p. 1430). The hyperkalemia was evident from his potassium level of 6.9 mEq/L and his abnormal EKG. His EKG revealed prolongation of the PR interval and peaked T waves, a sign of severe hyperkalemia (Littmann & Gibbs, 2018). Hyperkalemia can also lead to muscle weakness or paralysis, and the weight of a limb without movement on the ground is enough to start the muscle ischemia (McCance & Huether, 2018, p. 117 & 1430).
The roommate mentioned that he was unaware of how long the patient had been lying on the ground, unresponsive. Then after the patient was responsive, he reported burning pain in areas of necrotic tissue over his hip and forearm. With rhabdomyolysis, muscle pain and weakness are common side effects, and along with the necrotic tissue, this could have led to the pain over his hip and forearm. The necrosis resulted from rhabdomyolysis starting to destroy the muscle cells while lying in the same position for an extended period of time.
In short, rhabdomyolysis is the breakdown of muscle tissue, and then this damaged tissue creates an unstable environment within the cells leading to electrolytes and other proteins spilling into the bloodstream, which often leads to cardiac and kidney issues (Centers for Disease Control and Prevention, 2019). Once these electrolytes and other proteins are free-floating in the bloodstream it leads to hyperkalemia and most commonly associated with rhabdomyolysis is increased creatine kinase (McCance & Huether, 2018, p. 1432). To confirm the diagnosis of rhabdomyolysis a serum creatine kinase level needs to be drawn.
The post please respond why you agree or disagree with her discussion.
Discussion One
Th appeared first on blitzarchive.com.