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

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

Unresponsiveness from reduced consciousness due to respiratory depression was the physiologic response to the stimulus and the response occurred because “Opioids induce respiratory depression via activation of μ-opioid receptors at specific sites in the central nervous system including the pre-Bötzinger complex, a respiratory rhythm generating area in the pons” (Boom et al., 2012).  Opioid overdose negatively affects the part of your brain that regulates breathing, resulting in ineffective breathing that could ultimately result in death.

The cells that are involved in this process

Opioids work by activating opioid receptors on nerve cells. “The opioid receptors family consists of three classical receptors: μ, δ and κ opioid receptors, all of which belong to the G-protein coupled receptors (GPCR) family with seven transmembrane domains”, (How Opioid Drugs Activate Receptors, 2018)

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

 Genetic factors can contribute to interindividual differences in opioid response and metabolism. Specific variations in genes encoding drug-metabolizing enzymes, such as cytochrome P450 (CYP450) enzymes, can affect how opioids are processed and eliminated from the body. Genetic variations in opioid receptors can also influence an individual’s sensitivity to opioids and their overall response to pain relief or side effects, (Smith, 2009).

Research suggests that gender can play a role in how individuals respond to opioids. Generally, women may experience greater sensitivity to opioids and may require lower doses for pain management compared to men. This difference may be attributed to variations in hormonal factors, body composition, and metabolism. However, it’s important to note that individual responses can still vary, and these differences are not absolute, (Smith, 2009).

There are two different aspects to this scenario, addiction, and the result of it.  As far as addiction goes, this has been studied heavily and is known to be heavily correlated with genetics.  Studies have found that 50% of a person’s risk of becoming addicted to a substance is within their genetic makeup (NIDA,2019).    Addiction is known to be both an environmental factor and a susceptibility caused by genetics.  Compartment syndrome, which is what I believe is going on in this scenario has little to do with genetics.  However, there is a study regarding Compartment syndrome and the GYG1 gene mutation that may make people more susceptible to this syndrome.  This gene is involved in muscle energy utilization, a mutation on this gene may put a person at a genetic predisposition to suffering from compartment syndrome more easily than others (Joseph et al., 2020).

This patient suffering an overdose developed in my opinion by compartment syndrome.  I have actually had a few patients in my experience of nursing with amputated limbs due to this.  It is not extremely common, but it happens enough that it is actually referred to as “found down” compartment syndrome.  This is due to pressure tissue injuries from patients either collapsing on an arm or leg or in this case a left hip and forearm and then laying there on that limb for extended periods of time.  So, we have an overdose, which then caused compartment syndrome, which led to hyperkalemia, which led to heart rhythm abnormalities.

Compartment Syndrome occurs from an increase in pressure within a closed osteofacial compartment.  This increase in pressure causes circulation to be impaired.  This often occurs in crush injuries, soft tissue injuries, and fractures (Compartment Syndrome, n.d.).  In this case “found down” compartment syndrome can be both from crushing injuries upon collapse or from impaired bloodflow from laying on the extremity for extended amounts of time.  The hyperkalemia occurs due to “Damage to the skeletal cell membrane, both from direct injury or the loss of energy and dysfunction of the cell membrane pumps, causes calcium and sodium to rush inside the cell, and causes substances such as myoglobin, potassium, uric acid and phosphorus to leak out of the cell (Dahlgren, 2015).  This free floating of the potassium causes it to systemically cause hyperkalemia.  The abnormal heart rhythm of prolonged PR interval and peaked T waves is common with extreme hyperkalemia.  Potassium is responsible for helping to control the electrical signals of the myocardium.

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