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Respond in the following ways: (POSITIVE COMMENT)

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Share insights on how the factor you selected( THE FACTOR I SELECTED IS ATTACHED BELLOW IN A DOCUMENT) impacts the pathophysiology of the disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

 

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Factors that Influence Disease

Scenario: A 23-year-old male presents to the emergency department with suicidal ideation and requesting detox from heroin. He has been homeless for the last four years, reports that he has many sexual partners, does not use contraceptives, uses heroin IV, and recently spent three months in jail for a drug-related offense. The patient complains of generalized fatigue and night sweats — the nurse practitioner orders several tests, including a sexually transmitted disease (STD) panel and a chest x-ray. The nurse practitioner suspects tuberculosis (TB), so the patient is moved to a negative pressure room. His results are positive for TB and human immunodeficiency virus (HIV).

The factor that I selected was the patient behavior. The patient was a high risk for STDs because he was using drugs IV and not engaging in safe sex practices. According to the World Health Organization (2018), people with HIV are 20-30 times more likely to develop active TB. Furthermore, he was recently in jail. This crowded institutionalized setting is known to increase the risk of contracting TB. The Centers for Disease Control and Prevention (n.d) lists coughing, pain in the chest, coughing up blood or sputum, weakness, weight loss, no appetite, chills, fever, and night sweats as symptoms. The patient complained of fatigue and night sweats.

TB is caused by an acid-fast bacillus that typically targets the lungs but can spread to other body systems. TB spreads via airborne droplets. Proximity to someone with active TB who is speaking, coughing, or singing can spread the disease very quickly. Once inhaled, the bacilli lodge in the upper lobe and cause localized inflammation (Huether, & McCance, 2017). The immune system attempts to kill the bacteria via engulfment by macrophages, but this is unsuccessful because the bacilli can resist the toxins released by the macrophages. The bacilli then replicate inside the macrophage, causing the formation of a tubercle. Tissues within the tubercle die, forming a cheesy material called caseation necrosis. This formation promotes the growth of scar tissue around the tubercle, isolating the bacteria from the host’s defenses. TB can remain in this state for long periods, also known as latent TB. Once the immune system is impaired, the TB can reactivate and even spread throughout the body.

Usually, the immune system is very good at identifying invading organisms and destroying them via phagocytosis. Unfortunately, TB is resistant to natural bodily defenses, which makes it a significant health care concern.

 

 

References

Centers for Disease Control and Prevention. (n.d.). Signs & Symptoms. Retrieved from https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

World Health Organization. (2018, September 18). Tuberculosis (TB). Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/tuberculosis

 

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Discussion: Factors that Influence Diseases

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Atherosclerosis is a disease where the inside of the arteries is clogged by substances known ad plaque. Plaque is a combination of a number of other different substances including fat deposits, calcium, cholesterol and other substances that could be found in the blood. When plaque is allowed to build up because of failure to detect or because of failure to adhere to medications and other therapies, it becomes hard and this leads to the narrowing of the arteries where there is build-up of plaque. The result is that oxygen-rich blood is prevented from effectively flowing to different organs and this may lead to adverse health events. Normally, stroke, heart attack and eventually death are the results of atherosclerosis (Bentzon, Otsuka, Virmani & Falk, 2014). Atherosclerosis is associated with significant morbidity and mortality in the United States today. Worldwide, this disease is considered to be the leading cause of vascular disease, mostly manifested as ischemic heart disease, ischemic stroke and peripheral arterial disease (Herrington, Lacey, Sherliker, Armitage & Lewington, 2016). The cost of treating atherosclerosis and the disease burden on the healthcare system is also significant.

It is important to understand that there are a number of risk factors associated with atherosclerosis including, age, ethnicity, race, gender, diabetes, inflammation, genetics, lifestyle behavior such as unhealthy eating, smoking and finally, lack of physical activities among others (Rafieian, Setorki, Doudi, Baradaran & Nasri, 2014). For the purpose of this paper, the factor that shall focused on is age. Evidence has shown that with age, plaque builds up in the arteries increasing the risk of developing the disease. To be specific, the risk in men increases after the age of 45 while the risk in women increases after the age of 55 (Rafieian, Setorki, Doudi, Baradaran & Nasri, 2014). The importance of age in development of atherosclerosis cannot be overstated. This is a disease that develops with time and this is why age is a significant factor. After decades of eating unhealthy foods, drinking, smoking and lack of exercise, the chances of plaque building up in arteries increases. In addition, with age, other diseases that act as risk factors for atherosclerosis may also develop such as hypertension and diabetes. This is why age is a major risk factor for atherosclerosis.

Notably, atherosclerosis has been classified as an aging disease. In the light of this, it is safe to actually consider age as an independent factor for atherosclerosis. In cases of premature aging, atherosclerosis has been established as well. This is because plaques have illustrated instances of cellular senescence that is characterized by reduction in cell proliferation, growth arrest that is irreversible increased DNA change, apoptosis, telomere shortening and dysfunctions and epigenetic modifications (Wang & Bennett, 2012). Studies have shown that atherosclerosis starts from teenage years but the effects are felt in later years. This is why most elderly persons are the ones with the symptoms. Ideally, atherosclerosis is caused by lipid retention as well as modification and oxidation which triggers chronic inflammation at areas that are susceptible such as the walls of major arteries (Insull, 2009)

When an individual has atherosclerosis, the most common symptoms are associate with the fact that there are difficulties in different organs receiving sufficient oxygen and the heart may end up struggling more than it should to pump blood to the affected areas. As such, the common symptoms include chest pain or angina, shortness of breath, fatigue, weakness in leg muscles because of reduced blood circulation, pain in the areas where the arteries are blocked. The mechanism of the plaque could lead to manifestation of other complications when a patient has atherosclerosis. For instance, plaque may rupture leading to stenosis or thrombosis. When surfaces of some plaque are eroded, they may also rupture and this may also trigger thrombosis.

 

 

References

Bentzon, J. F., Otsuka, F., Virmani, R., & Falk, E. (2014). Mechanisms of plaque formation and rupture. Circulation research114(12), 1852-1866

Herrington, W., Lacey, B., Sherliker, P., Armitage, J., & Lewington, S. (2016). Epidemiology of atherosclerosis and the potential to reduce the global burden of atherothrombotic disease. Circulation research118(4), 535-546.

Insull Jr, W. (2009). The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. The American journal of medicine122(1), S3-S14

Rafieian-Kopaei, M., Setorki, M., Doudi, M., Baradaran, A., & Nasri, H. (2014). Atherosclerosis: process, indicators, risk factors and new hopes. International journal of preventive medicine5(8), 927.

Wang, J. C., & Bennett, M. (2012). Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circulation research111(2), 245-259

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